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Fatalities of Children in
North Carolina
2005
Annual Report
North Carolina Child Fatality Prevention Team
North Carolina Office of the Chief Medical Examiner
2007
NC Child Fatality Prevention Team Annual Report, 2005.
STATE OF NORTH CAROLINA
Michael F. Easley, Governor
DEPARTMENT OF HEALTH & HUMAN SERVICES
Dempsey Benton, Secretary
DIVISION OF PUBLIC HEALTH
Leah Devlin, State Health Director
www. ncdhhs. gov www. ncpublichealth. com
The Department of Health and Human Services does not discriminate on the basis of race, color, national origin, sex, religion, age or
disability in employment or the provision of services.
Copies of this document can be found at: www. ocme. unc. edu
NC Child Fatality Prevention Team Annual Report, 2005.
OFFICE OF THE CHIEF MEDICAL EXAMINER
John D. Butts, MD
Chief Medical Examiner
Deborah L. Radisch, MD, MPH
Associate Chief Medical Examiner & Child Fatality Prevention Team Director
CHILD FATALITY PREVENTION TEAM &
OFFICE OF THE CHIEF MEDICAL EXAMINER
STAFF
Krista Ragan, MA
Child Death Investigation & Research
Lisa Mayhew, MS
Child Death Investigation & Training
North Carolina Department of Health and Human Services
Division of Public Health
Office of the Chief Medical Examiner
Brinkhous- Bullitt Building UNC- CH
Campus Box 7580
Chapel Hill, North Carolina 27599- 7580
Courier 17- 61- 02
Tel ( 919) 445.4414
Fax ( 919) 962- 6263
Report Prepared By:
Krista Ragan, MA, Child Fatality Research Director
Deborah Radisch, MD, MPH Director of the NC Child Fatality Prevention Team
North Carolina Child Fatality Prevention Team, Office of the Chief Medical Examiner
NC Child Fatality Prevention Team Annual Report, 2005.
North Carolina Child Fatality Prevention State Team Membership
2006- 2007
Chair
John Butts, MD
Chief Medical Examiner
NC Department of Health and Human Services
Deborah Radisch, MD, MPH ( designee)
Associate Chief Medical Examiner
Child Fatality Prevention Team Director
NC Department of Health and Human Services
Members
Selena Berrier
NC Child Fatality Task Force
Keith Davis
Division of Social Services
NC Department of Health and Human Services
Al Deitch
Youth Advocacy & Involvement Office
NC Department of Administration
Mike East
North Carolina State Bureau of Investigation
Brenda Edwards
Division of Public Health
NC Department of Health and Human Services
Anita Evans
Division of Social Services
NC Department of Health and Human Services
Cynthia Floyd
NC Department of Public Instruction
Phyllis Fulton
Division of Social Services
NC Department of Health and Human Services
NC Child Fatality Prevention Team Annual Report, 2005.
Kim Howes
Prevent Child Abuse NC
Gerri Mattson, MD
Children & Youth Branch
NC Department of Health and Human Services
Susan E. Robinson
Office of Prevention & Early Intervention
Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
NC Department of Health & Human Services
Shikha Sinha
Public Representative
Angenette Stephenson
Office of the Attorney General
State of North Carolina
Jane Volland
Guardian Ad Litem Program
NC Administrative Office of the Courts
John Weil
Division of Social Services
NC Department of Health and Human Services
NC Child Fatality Prevention Team Annual Report, 2005.
Table of Contents
Introduction .................................................................................................. 1
The North Carolina Child Fatality Prevention System..................... 1
Methods............................................................................................. 1
Notes about the data.......................................................................... 1
Executive Summary...................................................................................... 3
Key Data Points............................................................................................ 6
Accidental Deaths......................................................................................... 7
Asphyxiation..................................................................................... 7
Drowning........................................................................................... 9
Fire................................................................................................... 11
Gun .................................................................................................. 11
Vehicle............................................................................................. 12
Toxins.............................................................................................. 20
Other................................................................................................ 23
Homicides.................................................................................................... 24
Child Abuse Homicide.................................................................... 24
Other Homicide............................................................................... 25
Natural Deaths............................................................................................. 26
Sudden Infant Death Syndrome...................................................... 27
Suicides....................................................................................................... 30
Undetermined Manner................................................................................ 32
Neglect........................................................................................................ 33
Non- North Carolina Resident Deaths......................................................... 34
Fetal Deaths................................................................................................. 36
Glossary....................................................................................................... 37
NC Child Fatality Prevention Team Annual Report, 2005. 1
Introduction
The North Carolina Child Fatality Prevention System was established by the legislature in
1991 with the creation of the Child Fatality Task Force. In 1992, the North Carolina Child
Fatality Prevention Team ( State Team) was created. Local ( county) Child Fatality Protection
Teams ( CFPTs) followed in 1995. The purpose of the system is to:
( 1) develop a community- wide approach to the problem of child abuse and neglect,
( 2) understand the causes of childhood deaths;
( 3) identify any gaps or deficiencies that may exist in the delivery of public agency
services that are designed to prevent future child abuse, neglect, or deaths;
( 4) make and implement recommendations for changes to laws, rules, and policies that
will support the safe and healthy development of our children and prevent future child
abuse, neglect, and deaths.
The State Team has the important duty of reviewing all deaths of children under the age of
18 years that occur within North Carolina and that are investigated and certified by the
Office of the Chief Medical Examiner ( OCME). The State Team then presents
recommendations to the Task Force for changes to any law, rule, or policy that would
promote the safety and well- being of children.
This report is also a resource for public education to encourage the citizens of North Carolina
to actively participate in improving the safety and well- being of the children of North
Carolina.
Methods
The State Team reviews all deaths of children that are investigated by the OCME. Deaths
reported to the OCME include: accidents, homicides, suicides, violent deaths, suspicious
deaths, and sudden, unexpected deaths ( including some natural deaths).
State Team staff examines each case and determines if additional data should be gathered for
a thorough review. Additional information that is often requested includes: law enforcement
reports, medical records, Child Protective Services records, and other information deemed
pertinent to the review.
Notes About the Data
Data Exclusions
Not all deaths of children that are investigated by the OCME are included in the main
summary throughout this report. These deaths, and reasons for exclusion, are:
Fetal Deaths
A small number of fetal deaths are reported to the OCME each year due to a number of
factors. A fetal death is a death of fetus that never lived outside of the uterus. A certificate of
NC Child Fatality Prevention Team Annual Report, 2005. 2
fetal death indicates that there was no birth; therefore, these deaths are not included in child
fatality numbers. However, they are reported separately in this report.
Non- Residents
When a person dies in North Carolina, a North Carolina death certificate will be issued. This
includes individuals who may be here on vacation, visiting or just passing through. In many
instances, decedents were injured in neighboring states and were brought to a hospital in
North Carolina for treatment and subsequently expired. Since the State Team is charged with
the protection of the child residents in North Carolina, non- residents are not included in the
overall tally. However, to ensure that these deaths do not get lost in the system, and
recognizing that some of these deaths may be due to risks found in North Carolina, the deaths
are recorded separately at the end of the report.
Differences Among Data Sets
State Center for Health Statistics Data
Data released from the State Center for Health Statistics ( SCHS) are based solely on death
certificate coding. The SCHS data set includes all deaths of children in North Carolina. As
not all deaths are reported to the OCME, the SCHS numbers are higher mainly due to the
natural deaths that are reported to the State Center. The data sets for the SCHS also close,
meaning that the counts for a particular period of time will not change if the death certificate
is revised. The OCME data never close. A cause and manner of death can change if new
evidence is found that would deem the change necessary. Also, the CFPT collects additional
information on each death and performs an in- depth review of each case. This information
allows the CFPT to analyze and classify data differently than the State Center.
Differences among CFPT Data Sets
Annual data sets may differ from time to time in CFPT data reports. There are several
reasons for the differences. The first is that a death may not be discovered in the same year as
it occurred. For instance, if a death occurred in 2005 but was not reported to the OCME until
2007, it would be an additional 2005 death. The State Team also database underwent a
transformation in 2006, collecting more detailed data so that deaths can be analyzed in
greater detail. These data may not have been available or collected in previous years and may
be reflected somewhat differently in newer reports.
Rates
The SCHS releases deaths based on population rates. Rates will not appear in this report
because the numbers are generally too small to have significant meaning. As not all child
deaths are investigated by the OCME, rates are better reported by the SCHS which handles
all birth and death certificates as well as population data. Data for 2005 from the State Center
can be found at www. schs. state. nc. us/ SCHS/ deaths/ child/ cd2005. html
NC Child Fatality Prevention Team Annual Report, 2005. 3
Executive Summary: Child Fatalities in North Carolina in 2005
The NC State Center for Health Statistics ( SCHS) reported that there were 1614 deaths of
residents of North Carolina under the age of 18 years in 2005. While 625 total child fatalities
were investigated by the Office of the Chief Medical Examiner, 24 deaths were of out- of-state
residents and 18 were fetal deaths. Therefore, of the deaths in 2005 that were reviewed
by the CFPT, 583 were child residents of North Carolina ( 36% of resident child deaths).
Age Group SCHS CFPT Percentage
Infant 1077 222 21%
1- 4 years 141 80 57%
5- 9 years 86 51 59%
10- 14 years 111 63 57%
15- 17 years 199 167 84%
Total 1614 583 36%
Table 1. Child Fatalities in North Carolina, 2005.
This report reflects only data obtained through review by the State Child Fatality Prevention
Team ( CFPT).
Deaths by Manner and Age
Infants
The leading manner of death for infants was natural, 67% ( 148) of infant deaths. Of those
deaths, 73% ( 108) were classified as Sudden Infant Death Syndrome ( SIDS). The second
leading manner of death was accident making up 21% ( 47) of the deaths, followed by
homicide at 9% ( 19).
Other Age Groups
Accidents were the leading manner of death for all age groups from 1 year through 17 years,
making up 37% of the deaths. The other manners of death varied with age groups.
• For both the 1 to 4 years and 5 to 9 years age groups, the second leading manner of
death was natural, accounting for 26% and 22% respectively. The third leading
manner of death for these two age groups was homicide, accounting for 18% of
deaths in the 1 to 4 years group and 8% of the deaths of the 5 to 9 years group.
• For the 10 to 14 years age group, natural causes and homicide were the second
leading manners of death, each accounting for 13% of the deaths. The third leading
manner of death for this age group was suicide, at 11%.
• Homicide was the second leading manner of death for the 15 to 17 years age group,
with 20% of the deaths, followed by suicides with 13%.
NC Child Fatality Prevention Team Annual Report, 2005. 4
Accidental Deaths
There were 262 accidental deaths in 2005:
• Vehicle 61 %
• Asphyxiation 17 %
• Drowning 6 %
• Toxin 6 %
• Firearm 1.5%
• All other means accounted for 1% or less ( each) of the total number of accidental
deaths
Vehicle- related deaths accounted for the greatest number of accidental deaths. Accidental
asphyxiation made up a rather large proportion of accidental deaths considering all means
categories; this category has increased by 35 percent in the past six years.
Homicides
There were 79 homicides in 2005:
• Child Abuse Homicides 44%
• Other homicides 56%
Child Abuse Homicide victims were more often under the age of 4 years while other child
homicide victims were more likely to be between the ages of 15 and 17 years.
Natural Deaths
There were 197 natural deaths in 2005:
• SIDS 55%
• Other 45%
The majority of SIDS deaths occurred at the age of 6 months and younger and peaked
between the ages of 1 and 2 months. Other natural deaths were mainly due to respiratory tract
infections, myocarditis, asthma and neurologic conditions.
Suicides
There were 28 suicides in 2005:
• Firearm 61%
• Asphyxia 39%
The majority of decedents were white males. The cause of death in the majority of deaths
was a gunshot wound while the remaining deaths were due to asphyxiation. Approximately
1/ 3 of the decedents had been diagnosed with a mental health disorder.
NC Child Fatality Prevention Team Annual Report, 2005. 5
3.99 4.15
49.25
9.31
45 33.27
13.55
33.61
4.8 3.08
0
20
40
60
80
100
Accident Homicide Natural Suicide Undet
2004
2005
Figure 1. Percent Total Change from 2004 to 2005, NC Child Fatalities.
According to CFPT data, total accidental child fatalities decreased by 4.25% from 2004 to
2005. Homicides, however, increased by the same amount ( 4.25%) from 2004. Natural
deaths reviewed by the CFPT remained steady at approximately 33% of the total child
fatalities for both 2004 and 2005. Suicides increased by 1% and undetermined manner deaths
decreased by 1 percent.
NC Child Fatality Prevention Team Annual Report, 2005. 6
KEY DATA POINTS
Accidental Asphyxiation:
• The number of child deaths from accidental asphyxia has increased 35% over
the past 6 years.
• The majority ( 82%) of children dying by accidental asphyxia were under the age
of 1 year.
• The total number of deaths from accidental overlying in 2005 ( 23) was 2 ½ times
the number seen in 2003.
• Sleep environment was a direct cause of or contributed to the death in 37 of the
45 accidental asphyxiation deaths.
o Approximately half ( 55%) of the decedents who died from asphyxia while
co- sleeping were sleeping with only 1 adult.
• Other environmental factors such as soft sleep surface or access to dangerous
items caused the deaths of several infants.
* for a full report on accidental asphyxiation deaths of infants, please contact the CFPT.
Accidental Drowning:
• The majority ( 71%) of drowning deaths occurred when children were
unsupervised.
• Younger children were more likely to drown when falling into the water rather
than participating in a water activity while older children were more likely to
drown in natural bodies of water while swimming.
Accidental Vehicle Deaths:
• The majority of motor vehicle occupant deaths were child passengers ( 66%).
• In child passenger deaths, the driver of the vehicle in which the decedent was an
occupant was found to be at fault in 78% of the crashes.
• For teen drivers, the main factors in crashes were error ( 30%) or speed and
error ( 22%).
• Teen passengers were least likely to wear seatbelts ( 39%), and only half ( 53%) of
teen drivers were wearing seat belts.
• Only 1 of the 7 ATV riders was wearing a helmet. Notably, a state law that
requires all ATV riders to wear helmets went into effect December 2005.
Homicides:
• The number of homicides in 2005 ( 79) was the greatest number recorded since
2000. Both Child Abuse Homicides and “ Other” homicides are increasing.
Suicides:
• The majority of firearm suicides involved handguns.
• Approximately 1/ 3 ( 36%) of the decedents had a diagnosed mental health
disorder.
NC Child Fatality Prevention Team Annual Report, 2005. 7
ACCIDENTAL DEATHS
Accidental death was the leading manner of death for children ages 1 year to 17 years in
North Carolina in 2005 with 262 deaths. Accidental deaths are those deaths that occur in
which there was 1) no intent to harm self or another, or 2) there was no knowledge that a
person would be seriously injured by their own or another’s action. Accidental deaths may
also be termed “ unintentional.” Accident is used in this report because that is the manner of
death used on the death certificate.
Figure 2. Accidental Deaths by Means, NC Children, 2005.
Examination of accidental deaths by means showed:
• The majority ( 61%) of accidental fatalities occurred in vehicle collisions.
• Asphyxiation accounted for 17% of accidental deaths.
• Drowning deaths accounted for slightly more than 6% of accidental deaths.
• Accidental toxicity ( drugs, poisons, etc.) accounted for another 6% of deaths.
• Fire- related injuries comprised 4% of accidental deaths.
• Firearm injuries accounted for 1.5% of accidental deaths.
• All other accidental means accounted for 1% or less ( each).
Accidental Asphyxiation Deaths
Data indicate child deaths from accidental asphyxiation in North Carolina are on the rise. The
peak number of 45 occurred in 2005, which was a 181% increase from 2000, when the
number was just 16 deaths. Infants are most at risk for asphyxiation, with sleep practices
being important factors in this type of death.
The majority of children were white at 49% ( 22), followed by black at 42% ( 19), and Asian
at 2% ( 1). Three ( 7%) of the children were of Hispanic ethnicity ( race was not identified).
45
17 11 4 16 8
161
0
20
40
60
80
100
120
140
160
180
Asphyxia
Drowning
Fire
Gun
Vehicle
Toxin
Other
NC Child Fatality Prevention Team Annual Report, 2005. 8
37
4
1 2 1
0 5
10
15
20
25
30
35
40
Infant
1- 4 years
5- 9 years
10- 14 years
15- 17 years
Figure 3. Accidental Asphyxiation Deaths by Age, NC Children, 2005.
Asphyxiation deaths can be broken into categories by examining the circumstances of the
death. In 2005, the circumstances were as follows:
5
23
8
4 5
0
5
10
15
20
25
Asp/ Choke
Overlying
Positional
Smothering
Other
Figure 4. Accidental Asphyxia Deaths by Category, NC
Children, 2005.
Asphyxia and Sleep Practices & Environment
Of the 45 deaths, risky sleep practices or environment were found to be contributory, if not
responsible for the death in 37 cases:
• Co- sleeping occurred in 89% ( 33) of the deaths.
o In 70% of the deaths, co- sleeping was the direct cause of death ( overlying).
o The remaining deaths were positional ( 15%), smothering ( 12%) and 1
mechanical asphyxiation death.
o The majority of decedents ( 55%) were co- sleeping in beds, followed by 39%
sleeping on couches.
o In 55% ( 18) of the deaths, the child was sleeping with only one adult,
followed by both parents/ adults and a sibling( s) at 24% ( 8).
The majority of
children who died
from accidental
asphyxia in 2005
were under the age
of 1 year ( 82%).
Male children
made up 60% ( 27)
of the deaths, and
females made up
40% ( 18) of the
deaths.
Approximately half ( 51%) of
the accidental asphyxiation
deaths in 2005 were due to
overlying. Positional asphyxia,
which occurs when someone's
position prevents them from
breathing adequately, accounted
for 18% of the deaths,
aspiration or choking for 11%
of the deaths and smothering for
9% of the deaths. There was one
death from hanging, one death
from ligature strangulation, 2
deaths from mechanical
asphyxiation, and 1 death from
entrapment.
NC Child Fatality Prevention Team Annual Report, 2005. 9
o In 15% ( 5) of the deaths, the co- sleeper was known to be under the influence
of drugs and/ or alcohol at the time of the death.
􀂃 In 67% of the deaths, no information was available about the co-sleeper’s
drug or alcohol use.
• Sleep surface/ environment ( i. e. soft surface, access to strings, etc) was a factor in 4
deaths.
Other Asphyxiation Deaths
There were 8 deaths in which sleep environment was not a factor in the death. These deaths
included:
• Two deaths of children ages 2 years and 15 years who choked on food while eating.
• One death of a 14- year- old who died when a sand pile collapsed on him ( entrapment).
• One death of a 5- year- old who died after being found underneath a forklift
( mechanical).
• One death of a 13- year- old as a result of accidental hanging.
• Two deaths of 1- year- olds from aspiration ( one of which aspirated cleaning solution
when falling into a bucket, the other aspirated food).
• One death of an infant less than a month old who aspirated on formula when the
infant was left alone to feed with a bottle propped up on a pillow.
Accidental Drowning Deaths
In 2005, there were 17 child deaths due to drowning. The majority of deaths occurred in
natural bodies of water. In North Carolina, the largest factor in childhood drowning deaths is
lack of supervision.
Figure 5. Accidental Drowning Deaths by Race, NC Children, 2005.
Five children were 4 years old or younger, five children were between the ages of 5 years and
9 years. Three children were between the ages of 10 years and 14 years. Four children were
between the ages of 15 years and 17 years.
Half ( 9) of the children
who drowned were white.
Four ( 24%) were black
and 1 was identified as
biracial. Four ( 22%) of the
children were Hispanic,
and 3 of those did not
have an identified race.
Sixteen decedents were
male and 1 was female.
52%
24%
6%
18%
White
Black
Biracial
Unknown
NC Child Fatality Prevention Team Annual Report, 2005. 10
Three main activities resulted in drowning deaths:
• Falls
o All of the children 6 years old and younger died after falling into water while
walking, playing or during an unknown activity.
• Swimming
o All of the teenagers aged 15 to 17 years died while swimming. A 12- year- old,
a 7- year- old and an 8- year- old also died while swimming.
• Boating
o Two 14- year- olds died while boating ( separate incidents).
There were several locations in which drowning occurred:
• The majority ( 59%) of deaths occurred in natural bodies of water:
o 3 children died in ponds
o 3 children died in the ocean
o 2 children died in rivers
o 2 died in lakes
• Six ( 35%) children drowned in pools and one child ( 6%) died in a hot tub:
o 5 of the pools had fencing, 1 fence was noted to be in disrepair
o 3 of the pools were in- ground, 2 were above- ground and one pool type was
not identified.
2 2 1
2 3
2 1
4
0
2
4
6
8
10
12
Natural Pool Hot Tub
15- 17 years
10- 14 years
5- 9 years
1- 4 years
Figure 6. Accidental Drowning Deaths by Age and Location, NC Children, 2005.
Younger children ( 9 years and under) drowned in pools/ hot tub at only a slightly higher
number than in natural bodies of water. Older children ( 10 years and older) almost
exclusively drowned in natural bodies of water.
Supervision status and lack of safety precautions were the main factors in drowning deaths:
• The majority of decedents ( 71%) were not being supervised at the time of the
drowning.
• Only 3 children, all teenagers, were known to be able to swim.
• No child was wearing a personal flotation device ( PFD) at the time the drowning
occurred.
NC Child Fatality Prevention Team Annual Report, 2005. 11
Accidental Fire & Burn Deaths
There were 10 child fatalities due to 8 residence fires and 1 death due to burns from an
accidental gasoline fire.
5
4
1 1
0
1
2
3
4
5
6
1- 4 yrs 5- 9 yrs 10- 14 yrs 15- 17 yrs
Figure 7. Fire Deaths by Age, NC Children, 2005.
In residence fires, the structures were:
• Houses in 2 deaths.
• A mobile home in 1 death.
• Apartments in 3 deaths.
• In 2 deaths the structure information was unavailable.
The causes of fatal fires in 2005 were:
• Cooking in 3 deaths.
• Children playing with lighters in 2 deaths.
• A kerosene heater in 1 death.
• Faulty wiring in 1 death.
• A smoldering cigarette in 1 death.
• In 2 deaths the cause of the fire could not be determined.
Supervision and safety precautions:
• In 7 deaths there was no supervision or a lack of proper supervision at the time of the
fire.
• In 3 of the 8 residential fires, the residence was known to have an operational smoke
detector. In the remaining 5 fires records did not indicate if there was an operational
smoke detector in the home.
Accidental Firearm Deaths
Of the 61 gun deaths of children in North Carolina in 2005, 4 deaths were determined to be
accidental in nature. Accidental firearm deaths generally are assigned this manner when the
Five children were
between the ages of 1 and
4 years, 4 children were
between the ages of 5 and
9 years. One child was 13
years of age and 1 child
was 17 years of age.
Five children were black,
6 were white. Six children
were male and 5 children
were female.
NC Child Fatality Prevention Team Annual Report, 2005. 12
child shot himself or herself unintentionally or the shooter was another child who most likely
did not know the consequences of his or her actions.
All decedents were male. Three ( 3) children were white and 1 was black. The decedent ages
were:
• 4 years
• 6 years
• 12 years
• 13 years
The circumstances of these deaths include:
• In 2 deaths the decedent was shot by another child while playing.
• In 2 deaths the wounds were accidentally self- inflicted.
o One death was a hunting accident.
o In one death the decedent found a weapon and accidentally shot himself.
• In 3 deaths an adult was present at the time of the fatal injury, but in no deaths were
the children under immediate supervision; in 1 death no adult or supervisor was
present.
• Three of the children were killed in their own homes; one child was outdoors.
The weapons were a handgun, a shotgun and 2 rifles. Gun storage safety laws were
created to prevent these types of deaths. In 1 death the firearm was being used in a hunting
scenario and gun storage laws did not apply. Gun storage information on the remaining
cases include:
• In all 3 deaths the weapons were not properly stored and were easily accessible to
children.
o In 2 deaths the owner or responsible party for the weapon was charged with
failure to secure a firearm.
o In 1 death the child’s caretakers were each charged with failure to secure a
firearm and involuntary manslaughter.
Vehicle- Related Accidental Deaths
Vehicle- related death is the leading means of death of children over the age of 1 year in
North Carolina. In 2005, 161 children died as the result of injuries sustained in vehicular
crashes.
To better understand how our children are dying, the circumstances of the motor vehicle
deaths were analyzed and broken down into categories:
• There were 112 deaths in which the decedent was the driver or a passenger in a
automobile at the time of the fatal injury ( occupant).
NC Child Fatality Prevention Team Annual Report, 2005. 13
• 24 children died as a result of being struck by a motor vehicle while walking or
standing near a street or in a driveway ( pedestrian).
• There were 7 deaths resulting from ATV crashes.
• There were 7 children who were struck while riding a bicycle.
• 3 children were struck while driving a motorcycle/ motorbike.
• 8 deaths were coded as other vehicle/ transportation deaths.
Motor Vehicle Occupant Deaths
Decedents were either a driver or passenger in a motor vehicle in 104 crashes resulting in 112
deaths:
• Decedents were drivers in
33% ( 37) of the crashes.
• Decedents were passengers in
65% ( 73) of the crashes.
• Two infants were born as a
result of maternal trauma in a
motor vehicle accident and
died shortly after the crash.
Figure 8. Vehicle deaths by Decedent Position, NC Children, 2005.
Decedent as Driver
There were 37 deaths in which the decedent was the driver of the vehicle:
• Half of the drivers ( 18) were 17 years old.
• 46% ( 17) were 16 years old.
• 1 driver was 15 years old.
• 1 driver was 8 years old ( unsupervised on private road).
Male drivers accounted for 70% of fatalities, females for 30% of deaths. The majority of
drivers were white 75% ( 27) and black drivers made up 22% ( 8). Two drivers were Hispanic.
Driver Seatbelt Use
In 51% ( 19) of the fatalities, the decedent ( driver) was known to be wearing a seatbelt and in
43% ( 16) the driver was not wearing a seatbelt. In 2 deaths information was not available or
seat belt use could not be determined.
32%
66%
2%
Driver
Passenger
Other
NC Child Fatality Prevention Team Annual Report, 2005. 14
34%
21% 15%
18%
12%
Error
Speed
Speed/ Error
Impairment
Other
Figure 9. Crash Cause when Decedent was at Fault, NC Children, 2005.
Driver Circumstance Information
Eighteen ( 49%) of the accidents were single- vehicle crashes and in 34 ( 92%) deaths the
decedent was responsible for the crash.
In deaths in which the decedent was responsible:
• Error was present in all of the crashes, but speed was also a factor in 15, weather in 3
deaths and other factors in 2 deaths.
• The main contributing factor in an additional 7 crashes was impairment due to
alcohol ( excessive speed was also present in 4 of these deaths).
Decedent as Passenger
There were 73 deaths of children who were passengers in motor vehicles when they sustained
fatal injuries and additional 2 children who died after being born due to the trauma of the
crash. Data here will address the 73 passengers.
Age Group Count
< 1 year 4
1- 4 years 9
5- 9 years 11
10- 14 years 16
15- 17 years 33
Total 73
Table 2. Passenger Deaths by Age Group,
NC Children, 2005.
Teenagers between the ages of 15 and 17 years accounted for the majority ( 45%) of
passenger deaths. The 10- 14 years age group accounted for 22% of the deaths, the 5- 9 years
group for 15% of the deaths and 1- 4 years for 12% of passenger deaths. Infants accounted for
the least ( 5%) amount of deaths.
NC Child Fatality Prevention Team Annual Report, 2005. 15
The majority of decedents were male ( 55%, 40) and 45% were female ( 33). White children
accounted for 60% ( 44) of the passenger deaths, black children for 25% ( 18), 2 children were
Native American, and 1 child was Asian. Eight children were of Hispanic ethnicity.
Passenger Seatbelt Use
Decedents were wearing a seat restraint or a child restraint in 47% ( 34) of the crashes.
Children between the ages of 1 and 4 years were most likely to be restrained ( 78%) while
the 15- 17 year age group passengers were least ( 39%) likely to be restrained. In 6 deaths the
information was not available or it could not be determined whether or not the decedent was
wearing a restraint.
36%
11%
30%
18%
5%
Error
Speed
Error & Speed
Impairment
Other
Figure 10. Passenger Deaths by Crash Cause, NC Children, 2005.
Passenger Circumstance Information
In 39 ( 53%) deaths, the crash was a single vehicle accident. The driver of the vehicle in
which the decedent was a passenger was found to be at fault in 56 ( 78%) of the deaths. In
these deaths, a teenager ( 15 through 17 years) was at fault in 18 deaths.
Crash causes in these deaths included:
• Driver error ( 22)
• Speed ( 7)
• Error and speed ( 18)
• Impairment by drugs and/ or alcohol or impairment ( with additional factors) was
present in 14 deaths.
o In 7 deaths, the supervisor of the decedent was the impaired driver.
􀂃 In 4 of those deaths, the driver was a parent of the decedent.
􀂃 In 2 deaths the driver was under the age of 21 years.
o Other ( 6)
o Unknown ( 9)
NC Child Fatality Prevention Team Annual Report, 2005. 16
Driver vs. Passenger Information
When examining occupant status of fatalities in motor vehicle crashes, 66% of the occupants
were passengers, 33% were drivers.
Age Group Driver % Passenger %
< 1 year 0 0 4 5%
1- 4 years 0 0 9 12%
5- 9 years 1 3% 11 15%
10- 14 years 0 0 16 22%
15- 17 years 36 97% 33 45%
Total 37 100% 73 100%
Table 3. Occupant Deaths by Position and by Age Group, NC Children, 2005.
The 15 to 17 year age group had the most passenger fatalities with 45%, followed by the 10-
14 year group ( 22%) and the 5 to 9 year group ( 15%).
Race Driver % Passenger %
Asian 0 0 1 1%
Black 8 22% 18 25%
Native Am. 0 0 2 3%
White 27 73% 44 60%
Hispanic 2 5% 8 11%
Total 37 100% 73 100%
Table 4. Occupant Deaths by Position and by Race/ Ethnicity, NC Children, 2005.
The majority of drivers were white ( 73%) as were the passengers ( 60%).
Table 5. Occupant Deaths by Position and Sex, NC Children, 2005.
Male drivers fatalities were more than double ( 70%) that of female driver fatalities.
Seat belt Use Driver % Passenger %
Yes 19 51% 34 47%
No 16 43% 33 45%
Unknown 2 5% 6 8%
Total 37 100% 73 100%
Table 6. Occupant Deaths by Position and Seatbelt Use, NC Children, 2005.
Of the 110 children who died in motor vehicle crashes, 48% were wearing seatbelts.
Approximately 51% of drivers were wearing seatbelts and 47% of passengers were wearing
seatbelts.
Sex Driver % Passenger %
Male 26 70% 40 55%
Female 11 30% 33 45%
Total 37 100% 73 100%
NC Child Fatality Prevention Team Annual Report, 2005. 17
Non- Occupant Deaths
There were 49 deaths of children who were not occupants of a vehicle.
24
7 7
3
8
0
5
10
15
20
25
30
Pedestrian
Bicycle
ATV
Motorcycle
Other
Figure 11. Non- Occupant Vehicle- Related Deaths, NC Children, 2005.
Pedestrian Deaths
There were 24 ( 47% of non- occupant deaths) children struck by a motor vehicle in 2005.
Age Group Count
1- 4 years 10
5- 9 years 3
10- 14 years 7
15- 17 years 4
Total 24
Table 7. Passenger Deaths by Age Group,
NC Children, 2005.
Children 4 years and under accounted for 42% of the pedestrian deaths. Ten children were
female and 14 were male. Ten children were black, 8 children were white, and 1 child was
Native American. Five children did not have an identified race but were noted to be of
Hispanic ethnicity.
NC Child Fatality Prevention Team Annual Report, 2005. 18
21%
79%
Driveway/ home Street
Figure 12. Pedestrian by Location of Injury, NC Children, 2005.
Pedestrian Circumstance Information
Nineteen ( 79%) decedents were struck in a roadway or street. All of the children struck in the
driveway or in front of their home were under the age of 5 years ( 5):
• Two children were struck by SUVs backing out of a driveway.
• Two children were struck by pickup trucks entering the driveway.
• One child was struck by a passenger car kicked out of gear by another child.
In 13 ( 54%) deaths, the driver of the vehicle was determined not to be at fault in the accident.
In most cases, the child ran into the road or was standing/ walking in or along the road when
they were unavoidably hit by a vehicle. Of the 7 deaths in which the driver of the vehicle was
determined to be at fault, 1 driver was impaired. In the remaining 4 deaths fault could not be
determined or was unknown.
Supervision information was difficult to obtain in motor vehicle- pedestrian collisions as the
information provided often comes from the DMV report and supervision status is not
captured on the form. Additional information may be obtained from Medical Examiner
reports or other sources. In the majority of deaths ( 58%) no information was available about
supervision. An adult supervisor was known to be present in 5 deaths under the age of 15
years and there was no supervision of 3 children between the ages of 10 and 14 years.
Bicycle Crash Deaths
There were 7 ( 17% of non- occupant deaths) children who died while riding bicycles that
were struck by motor vehicles:
Age Group Count
1- 4 years 0
5- 9 years 1
10- 14 years 3
15- 17 years 3
Total 7
Table 8. Pedal cyclist Deaths by Age Group,
NC Children, 2005.
NC Child Fatality Prevention Team Annual Report, 2005. 19
Six of the children were male, one was female. Three of the children were black and 2 of the
children were white. Two children were Hispanic.
Bicycle Circumstance Information
All of the decedents were struck while riding in the roadway or trying to cross a roadway.
In five deaths, the decedent was found to be at fault in the accident and in 2 deaths the driver
of the vehicle that struck the decedent was found to be at fault.
When examining safety issues:
• No child was wearing a helmet.
• In 4 deaths the child was not being supervised and in 3 deaths no information was
available about supervision.
ATV Deaths
There were 7 ( 17% of non- occupant deaths) children who died as a result of ATV crashes in
2005:
• 2 children were between the ages of 1 and 4 years
• 1 child was 5 years of age
• 2 children were between the ages of 10 and 14 years
• 2 children were 15 years of age
Two of the children were female and 5 of the children were male. Six children were white
and 1 child was black.
ATV Circumstance Information
Four of the deaths occurred at a residence or on private property, the remaining 3 occurred on
roads or highways. The four youngest children were passengers and the oldest 3 were drivers.
When examining safety issues:
• Only one child was known to be wearing a helmet ( no helmet information was
available in 1 death).
• In 3 deaths there was no supervision at the time of the crash
o In 1 death no information was available
o Adults were driving the ATV in 2 deaths
In addition to requiring helmet use the state’s ATV law, which went into effect in December
2005, also requires adult supervision for young ATV riders.
Motorcycle Deaths
There were 3 ( 7% of non- occupant deaths) deaths of children who were driving motorcycles.
All of the children were white males ages 8 years, 13 years and 15 years.
NC Child Fatality Prevention Team Annual Report, 2005. 20
Motorcycles in these cases included:
• 2 dirt bikes ( classified as motorcycles to be used off road)
• 1 small motorcycle
In 2 deaths the decedent drove into the path of an automobile on a road and in 1 death the
decedent struck another ATV.
When examining safety issues:
• Only one child was wearing a helmet.
• No information was available about supervision for any of these deaths.
Other
Other vehicular deaths don’t fit into the above categories for 1 of 2 reasons: 1) the vehicle is
not an automobile, or 2) the legal regulations that apply to motor vehicles would not apply in
these instances. There were 8 deaths that fell into this category.
• There were 3 deaths of teenage males ( 15 years, 16 years and 17 years) who were
walking on the train tracks when they were struck by a train.
• There were 2 children who were driving go- carts.
• There 12- year- old child who was riding a horse near a road ( while supervised) when
the horse darted into the road into the path of an oncoming vehicle.
• There was 1 death of a 6- year- old child who had sustained injuries years earlier when
he was struck by a riding lawn mower.
• There was one death of a 13- year- old male struck riding his skateboard.
Legal Ramifications
Charges were known to have been filed in 35 of all of the motor vehicle crash deaths and
charges were pending in another 7 cases. In 17 cases, more than one charge was filed.
Charges filed varied from regular traffic infractions to 2nd degree murder.
Accidental Toxin Deaths
Accidental deaths from toxins include accidental drug toxicity, unintentional ingestion of
chemicals, or exposure to lethal chemicals/ gases. There were 16 deaths due to toxins in 2005
( 2 deaths were related). The majority of these were of decedents who were misusing
prescription drugs for recreational purposes.
Most children ( 14) were between the ages of 15 and 17 years. One child was 14 years and
one child was 2 years old. Fifteen of the children were white and one child was black. Males
accounted for 13 deaths and females for 3 deaths.
NC Child Fatality Prevention Team Annual Report, 2005. 21
Decedents were most likely ( 56%) to be at home when they took a fatal dose of a toxin. In 4
deaths the decedent had taken drugs at a residence other than their own and in 3 deaths it was
not known or information was not available as to where the decedents were at the time they
took the toxin( s).
75%
6%
6%
13%
Recreational
Medical
N/ A
Undet
Figure 13. Decedent Drug Use Activity, NC Children, 2005.
The majority of decedents were using a toxin recreationally which resulted in their death:
• In 12 deaths the decedent was recreationally using a toxin ( or toxins) when they took
a lethal amount.
• In 1 death the decedent was taking the prescribed drug for medical reasons.
• In 1 death the child may have taken a drug not knowing that it was a drug.
• In 2 deaths the circumstances were unclear and it could not be determined why the
decedent was taking the drug( s) from the information available.
Ten of the decedents had a history of prior drug use and in 3 deaths there was a family
history of drug use.
Toxins
In 12 deaths the fatal toxin( s) was either a prescription drug or a mix of prescription and over
the counter ( OTC) drugs. In 3 deaths the toxins were combined prescription and illicit drugs.
In 1 death the decedent used a household chemical ( inhalant) to get high.
NC Child Fatality Prevention Team Annual Report, 2005. 22
3
12
3 1 4 2
13
1
3
2
1
1
1
1 0 2 4 6 8
10
12
14
16
18
Narcotics
Depressants
Stimulants
Anti- Depress
Other Rx
OTC
Other Illicit
Other
Lethal
Not- Leth
Figure 14. Positive Toxicology Findings in Accidental Toxin Deaths, NC Children, 2005.
As illustrated in Figure 14, very few decedents tested positive for only 1 toxin, with only 6
deaths ( 38%) resulting from a single toxin. In the 16 accidental toxin deaths, 48 toxins were
detected by toxicologic examination. These toxins included:
• Narcotics ( methadone, fentanyl, oxycodone, morphine, etc.)
• CNS depressants ( benzodiazepines, alprazolam, and barbiturates etc.)
• Stimulants ( i. e., prescription methamphetamine and illicit cocaine)
• Antidepressants ( i. e., sertraline)
• Inhalants
• Hallucinogens
• Other prescription drugs
• OTC drugs
In 5 deaths ( 31%) more than 1 drug was found to be present in a lethal amount and in another
5 deaths ( 31%) the decedent had 1 toxin present in a lethal amount but other drugs were
detected in non- lethal concentrations. Methadone was found in be lethal in 6 deaths, and the
sole lethal drug in 3 of those deaths.
Access to Toxins
Children and adolescents can gain access to legal and illegal drugs in a variety of ways from
a variety of locations:
• In 3 deaths the lethal toxin was in/ around the home, but not prescribed for the
decedent.
• In 1 death the decedent purchased the toxin at the store.
• In 1 death the drug was a prescription for the decedent for medical purposes.
• In 2 deaths the decedent had taken prescription drugs that were prescribed to him or
her as well as a prescription drug prescribed to someone else.
• In 1 death the decedent took a drug prescribed for someone else.
• In 4 deaths the decedent obtained the drug from a friend or acquaintance.
• In 4 deaths it was not determined how or where the child obtained the drug.
NC Child Fatality Prevention Team Annual Report, 2005. 23
Other Accidental Deaths
There were 8 deaths that occurred that can be classified as “ other accident” in 2005:
• Three deaths of infants occurred as a result of medical treatment ( surgical
complications) or drug reaction.
• An infant and a 7- year- old died from injuries sustained in falls ( separate incidents).
• A 2- year- old died when he pulled a heavy object over on himself.
• A 17- year- old male accidentally stabbed himself during an altercation.
• A 17- year- old male drowned in a ditch while trying to cross a flooded street after
heavy rain.
NC Child Fatality Prevention Team Annual Report, 2005. 24
HOMICIDE
There were 79 homicides in 2005. This is the greatest number of homicides recorded since
2000. Both Child Abuse Homicides ( CAH) and other homicides have been on the rise since
2002. Other homicides increased by 76% from 2004 to 2005.
Child Abuse Homicides
There were 35 homicides determined to be Child Abuse Homicides in 2005. The State Team
defines child abuse homicide as the death of a child that occurs from a physical injury and/ or
severe neglect that is perpetrated by the person in charge of the child's well- being at the time
of the fatal injury. Other homicides are those in which the decedent was killed by another
person, but not a person responsible for taking care of the child at the time of the death.
Victims of child abuse homicide were:
• Under the age of 4 years in 89% ( 31) of the deaths.
o Infants accounted for half ( 51%) of all child abuse homicides of NC residents
in 2005.
• Between the ages of 5 and 14 years of age in 2 deaths.
• Between the ages of 15 and 17 years of age in 2 deaths.
Figure 15. Fatal Injuries in North Carolina Child Abuse Homicides, 2005.
Causes of death vary, with 66% of victims dying from blunt trauma ( 6 of those from abusive
head trauma/ AHT). Asphyxiation was the cause of death in 4 fatalities. Scalding, lack of
newborn care and exposure resulted in 2 fatalities per cause of death. One child died from
stab wounds and 1 additional child died from drowning. In addition, half ( 18) of the children
showed evidence of abuse or a suspect admitted to abusing the child on more than 1
occasion.
Those suspected of inflicting the fatal injuries in child abuse homicides were either parents or
individuals responsible for the child’s well- being at the time of the injury:
Scalds
6%
Other
17%
AHT
17%
Asphyxia
11%
Blunt trauma
49%
NC Child Fatality Prevention Team Annual Report, 2005. 25
Suspected Perpetrators*
A biological parent was the suspected perpetrator in 43% ( 15) of the child abuse homicide
deaths:
• Mothers ( 7) and fathers ( 7) were equally suspected as perpetrators of fatal injuries,
with one case in which both a mother and father were charged.
• In 11% ( 4) of the deaths the stepfather alone was suspected.
• In 23% ( 8) of the deaths the mother’s boyfriend was charged with the murder, and in
2 of these deaths the mothers were also charged with lesser crimes related to the
death. In 1 death the mother and her boyfriend were both charged as primary
offenders.
• In 3 deaths the suspect was a male caretaker not related to the decedent, in 1 death the
babysitter was suspected, and in 1 death a family friend was suspected.
• No one was charged in 2 of the deaths, as primary suspects were not identified.
Other Homicides
There were 44 homicides of children that were not due to child abuse. Teenagers between the
ages of 15 and 17 years accounted for 73% ( 32) of the homicides.
Firearms were used in 89% ( 39) of the deaths, sharp instruments were used in 4 deaths and 1
homicide was due to drowning. Circumstance information varied greatly but included:
arguments, gang activity, perpetrating a crime, “ fooling around” with a weapon, domestic
violence, innocent bystander and in some deaths the circumstance information was not
available or not known.
Suspected Perpetrators*
The majority of suspects ( 51%) were between the ages of 15 and 21 years. The suspect-victim
relationships were:
• In at least 36% ( 16) of the deaths the decedent knew the suspect.
• Four decedents did not know the suspect before the death.
• In 4 deaths the suspect was not identified.
• In the remaining deaths ( 20, 45%) it was not known or information was not available
as to whether or not the decedent was acquainted with the suspect.
* NOTE: Suspected perpetrators are labeled as such as they have been charged with a crime but are presumed
innocent until found guilty in a court of law. The CFPT is tracking legal outcomes and the State Team will
report these findings at a later date.
NC Child Fatality Prevention Team Annual Report, 2005. 26
NATURAL DEATHS
The majority of natural child deaths in North Carolina are not reported to the Office of the
Chief Medical Examiner as they result from known illness or disease. However, sudden,
unexpected deaths of children in apparent good health must be reported to the medical
examiner. Most of these deaths will require an autopsy, with investigation, to determine the
cause and manner of death. In 2005, there were 208 deaths certified as natural manner. One
hundred and eight of these were finalized as Sudden Infant Death Syndrome and are
discussed later in this section. Another 12 deaths were fetal deaths and are discussed at the
end of this report.
Age Group Total
< 1 year 36
1- 4 years 18
5- 9 years 11
10- 14 years 7
15- 17 years 5
Total 77
Table 9. Sudden, Unexpected Deaths of Children
( excluding fetal deaths and SIDS) by Age Group, NC Children, 2005
The majority of children who died from sudden, unexpected death ( excluding SIDS and fetal
deaths were under the age of 1 year, accounting for 47% of these natural deaths. In fact, as
children got older, sudden unexpected death dramatically decreased.
Natural Causes of Death
Of the 77 remaining deaths, 69 ( 90%) were autopsied. In some deaths there may be overlap
such as when congenital abnormalities place a child at risk for pulmonary infections or may
involve serious heart defects that cause death. Deaths were categorized here by the main
factor contributing to the child’s death. Eight deaths were found to have no external cause of
death and were certified as natural in manner with unknown means. The top 4 ( as 2 causes
had the same number) causes of death were:
• Upper/ lower respiratory tract infections 15
• Myocarditis 11
• Asthma 5
• Neurologic conditions 5
Other natural causes of death varied and included: aspiration, complications of prematurity,
malignancy, meningitis, congenital heart disease, other congenital conditions, seizures,
complications of cerebral palsy, sepsis/ systemic viral illness, gastrointestinal infection, and
cardiomyopathy.
NC Child Fatality Prevention Team Annual Report, 2005. 27
Sudden Infant Death Syndrome
Sudden Infant Death Syndrome ( SIDS) is the sudden and unexpected death of an infant ( a
child under the age of 1 year). This cause of death should only be assigned when a complete
autopsy, complete scene investigation and a complete review of clinical history cannot show
any other cause of death. In North Carolina, the manner is determined to be natural. There
were 108 deaths certified as SIDS in 2005.
In North Carolina, most SIDS victims were less than 6 months old:
• SIDS deaths peaked between 1 and 2 months of age with 60% of all SIDS deaths
occurring between birth and 3 months.
• 98% ( 104) of SIDS deaths occur at the age of six months or younger.
11
26
28
14
12
10
3
1 2 1
0
5
10
15
20
25
30
< 1
mo
1 mo 2 mo 3 mo 4 mo 5 mo 6 mo 7 mo 8 mo 9 mo 10
mo
11
mo
Figure 16. SIDS deaths by Age, North Carolina Residents, 2005.
Demographics
Females accounted for 41% ( 44) of the SIDS fatalities and males for 59% of deaths. White
children accounted for 56% ( 61) of the deaths and black children for 33% ( 36). White males
accounted for 32% ( 35) of the deaths overall for a single race and sex. Seven ( 6%) of the
children were of Hispanic ethnicity.
Location of Death
The majority ( 92%) of children died at home while 2 died at licensed day care centers and 7
deaths occurred at residences other than the decedent’s home residence.
SIDS & Risk Factors
While the cause of SIDS is not known, “ risk factors” ( increase the risk for SIDS) have been
identified. These include tummy/ side sleeping, soft sleep surface/ loose bedding, smoking, co-sleeping,
preterm and low birth weights. Risk factor information in SIDS deaths for North
Carolina was:
NC Child Fatality Prevention Team Annual Report, 2005. 28
Bedding:
• In 50% ( 54) of the deaths, bedding information was not available or not known.
• In 23% ( 25) of the deaths, blankets were present and in 16% ( 17) of the deaths a
comforter was present with the decedent at the time of the death.
• Pillows were present in another 23% ( 25) of the deaths.
• In a small number of deaths ( 6), stuffed animals were in the sleeping area with the
decedent.
Co- sleeping & Sleep Surface:
• In 52% ( 56) of the deaths, the decedent was co- sleeping with at least one other
individual at the time of the death.
o Of the known co- sleepers, 30% ( 17) were sleeping with both parents at the
time of the death.
o The same number of children ( 17) were sleeping with the mother only.
o Infants were sleeping with at least 1 parent and 1 sibling in 21% ( 12) of the
deaths.
• Infants were sleeping in cribs in 20% of the deaths.
• The majority of infants were sleeping on sleep surfaces not intended for infant sleep
o Almost half ( 48%) of infants were sleeping in adult beds.
o Twelve were sleeping on couches.
o Four were sleeping in car seats.
o In 8 deaths ( 7%) the sleep surface was described as “ other”.
o In 9 deaths ( 8%) information about the sleep surface was not available.
30%
19%
14%
4%
33%
Back
Front
Side
Sitting
Unavail
Figure 17. SIDS Deaths and Infant body placement,
NC Children, 2005.
Infant Position:
• Slightly less than 1/ 3 ( 30%) of infants were known to be placed on their backs to
sleep, the recommended position for infant sleep.
• In 1/ 3 ( 33%) of the deaths, no information was available about the sleep position of
the infant.
NC Child Fatality Prevention Team Annual Report, 2005. 29
Smoker in the home:
• In 68% ( 74) of the deaths, it was not known if there was a smoker present in the
home.
• In 18% ( 20) of the deaths a smoker was present in the home
• 12% ( 13) of the homes did not have a smoker living in the residence
Pregnancy and Birth Risks:
• Approximately 28% ( 30) of the infants who died from SIDS were born prematurely.
o 14 of which were low birth weight.
• In 6% ( 6) of the deaths, the decedent was one product of a multiple birth.
• Mothers were known to have smoked during pregnancy in 9% ( 10) of the deaths.
NC Child Fatality Prevention Team Annual Report, 2005. 30
SUICIDE
In 2005, 28 children committed suicide in North Carolina. Seven of the children were
between the ages of 10 and 14 years and 21 were between the ages of 15 years and 17 years.
Suicide Circumstances
Circumstances surrounding suicides include location of occurrence, decedent and family
history and weapon use and access:
• The majority ( 24) of suicides took place at the decedent’s residence.
• Ten ( 36%) of the decedents had been diagnosed with a mental illness at some time
prior to their suicide.
• As in prior years, the mechanisms adolescents used to commit suicide were firearms
and asphyxia.
Firearms
Firearms were used in 61% ( 17) of the suicides:
• Males accounted for 82% ( 14) of the suicides by firearms, and 3 decedents were
female. Children between the age of 15 years and 17 years accounted for 76% ( 13) of
the deaths and 4 deaths were children ages 10 to 14 years.
• White children made up 76% ( 13) of the deaths, 3 children were black, and 1 child
did not have an identified race but was identified as Hispanic ethnicity.
53%
35%
12%
Handgun
Shotgun
Rifle
Figure 18. Suicides by Weapon/ Mechanism, NC Children, 2005.
• Handguns were used in 53% ( 9) of the deaths.
• Shotguns were used in 6 deaths and rifles were used in 2 deaths.
• In 47% of the deaths ( 8) the weapon belonged to a parent of the decedent.
• In 2 deaths the decedent was the owner of the weapon.
• In 5 deaths no information was available on the ownership of the gun or no one was
aware how the decedent obtained the gun.
NC Child Fatality Prevention Team Annual Report, 2005. 31
Gun storage information was as follows:
• In 1/ 3 of the cases ( 6), the storage information was not available in records or not
known.
• In 4 deaths the decedent was the owner of the gun ( 2) or storage was not applicable
( 2).
• In 2 deaths the guns were known to have been properly stored.
• In 5 deaths the firearm was known to be improperly stored.
• In only 1 of these deaths were charges brought against the owner of a firearm for
improper storage.
Asphyxia
Eleven ( 11) of the suicides were a result of asphyxia by hanging.
• Nooses included items found around the home such as electrical cords or belts.
• Eight ( 73%) of the decedents were female and 3 were male
• Teens aged 15 to 17 years accounted for 8 deaths ( 73%) and teens aged 10- 14 years
accounted for 3 deaths.
• White children accounted for 6 ( 55%) asphyxiation suicides, black children for 4
deaths and 1 child was identified as Hispanic ethnicity.
NC Child Fatality Prevention Team Annual Report, 2005. 32
UNDETERMINED MANNER
There were 18 deaths of children in 2005 for which a manner of death could not be
determined.
The majority of deaths that fell into this category were between the ages of 1 and 4 years ( 7),
followed by infants ( 6), 5- to 9- year- olds ( 3) and 15- to 17- year- olds ( 2).
Deaths that were undetermined in manner included:
• Deaths with an identified cause of death but with a manner or intent that could not be
determined from available investigative information:
o 1 death from a toxin
o 2 fire- related deaths
o 1 gun death
o 1 death by drowning
o 1 death by other means
• Deaths in which the cause of death was also undetermined ( 12) after an autopsy and
investigation could not provide information that could positively identify a particular
physical means of death.
NC Child Fatality Prevention Team Annual Report, 2005. 33
NEGLECT
Negligence can be defined as a failure to act, failure to attend to, or lack of due care. When
discussing child neglect, the definition can be dependent on legal, societal or cultural
standards. A consensus definition of child neglect does not exist. However, it is important to
examine the contribution of neglect in child fatalities when trying to determine prevention
strategies. The CFPT has modified existing neglect classifications so that we may better
capture the role of neglect in child deaths. For a death to be classified as neglect, the
following criterion must be met:
1. The act/ failure to act must be ( at a minimum) contributory to the death:
2. The person who committed the act or who failed to act must have had care- giving
responsibility for the child at the time of the fatal injury
3. The death could have been prevented if the caregiver had taken proper precautions
and/ or followed legal regulations meant to protect themselves and others.
A death can be classified as neglect when improper care, improper discipline, improper
supervision, inappropriate or lack of medical care, inappropriate parental behavior and/ or an
unsafe physical environment contributed to the death. It is also important to note that neglect
is not limited to accidental deaths; it can be a factor in other deaths as well. Also, the
numbers are undercounted, since complete circumstance information is not always available
for review. Other neglect may exist that is not related to the death.
Upon careful examination of the child fatalities in 2005, the CFPT concluded that 101 ( 17%)
of the 583 deaths of the cases reviewed met at least 1 category for neglect classification.
These deaths included:
• Abandoned infants 7
• Drowning 7
• Firearm 13
• Asphyxia 17
• Motor vehicle 23
• Blunt trauma 11
• Exposure 2
• Fire 7
• Scald 2
• Other 6
NC Child Fatality Prevention Team Annual Report, 2005. 34
NON- RESIDENT DEATHS
There were 24 deaths in North Carolina in 2005 of children who were residents of other
states or countries.
Of these, 16 deaths were accidents, 5 deaths were natural and 3 deaths were homicides.
Ages ranged from infants ( 6), 1- 4 years ( 5), 5- 9 years ( 4), 10- 14 years ( 2), 15- 17 years ( 7).
11
2 1
5
1 4
0
5
10
15
20
Accident Homicide Natural
Onset OOS
Onset NC
Figure 19. Location of Onset, Child Deaths in NC of Non- residents, 2005.
Accident
There were 16 accidental deaths:
• Motor vehicle crashes accounted for 12 child deaths.
o In 7 deaths, the crash occurred in North Carolina. Five of the crashes occurred
in nearby states and the child was brought to NC for treatment and they
subsequently died.
• Asphyxiation was the cause in 1 death ( onset in NC).
• Drowning was the means in 1 death ( onset in NC).
• One child died as a result of a gunshot wound ( onset in NC).
• Injuries sustained in a fall accounted for 1 death ( onset in NC).
Natural
There were 5 natural deaths:
• SIDS was the cause of death for 3 infants.
o Two of these deaths occurred in bordering states and the decedent was
brought to a hospital in North Carolina where the child was pronounced dead.
• One child had a terminal illness and was visiting in North Carolina.
• One child had myocarditis with a fatal event while visiting in North Carolina.
NC Child Fatality Prevention Team Annual Report, 2005. 35
Homicide
Three non- resident children died as a result of homicide:
• In 2 deaths, the children appeared to be living in North Carolina, but had a different
state listed as their residence on the death certificate.
o One death was a result of child abuse.
o One death a result of domestic violence.
• One child died from starvation ( child abuse) which occurred over a period of time and
in several states.
NC Child Fatality Prevention Team Annual Report, 2005. 36
FETAL DEATHS
Fetal deaths are not systematically reported to or investigated by the medical examiner
system. Eighteen fetal deaths were investigated in 2005 and 2 of those were listed as either
non- resident or no known residence. Of the 16 residents, 11 were determined to have been
Intrauterine Fetal Demise. The remaining 5 deaths were due to:
• Motor vehicle accidents 2
• Other accidental means 1
• Natural 1
• Undetermined/ Unknown 1
NC Child Fatality Prevention Team Annual Report, 2005. 37
GLOSSARY
Accident ( manner): The death was unintentional ( there was no intent to cause injury to the
decedent or another or lack of understanding that harm would result from actions
Asphyxiation: Lack of oxygen to the body/ brain ( for our purposes this will only refer to
deaths from lack of oxygen)
Aspiration: Inhalation or food/ liquid or gastric contents
ATV: All- Terrain- Vehicle
Child: From birth through the age of 17 years.
Child resident: under the age of 18 years living in North Carolina ( as noted on the death
certificate)
Choking: Obstruction within the air passage ( internal)
Co- sleeping: The child was placed to sleep on the same surface as at least one other
individual who was also sleeping/ intended on sleeping
Drowning: Water/ liquid prevents the body from obtaining oxygen resulting in death ( a form
of asphyxiation)
Entrapment: Trapped in an air- tight enclosure
Environmental deaths: Deaths that result from Cataclysmic storms ( i. e. winds and flooding
from hurricanes), cave ins, lightning and other natural environmental events.
Exposure: Result of hypothermia or hyperthermia.
Fetus: unborn young of a human being
Firearm: handgun, long gun, or modified weapon used to dispense projectiles
Hanging: Compression/ constriction of the neck structures by a constricting band tightened
under the victims body weight ( noose)
Homicide ( manner): Intentionally inflicted injury that is fatal or death is a known
consequence of an action by another
Infant: From birth to the 1st birthday
Ligature strangulation: Compression/ constriction of the neck structures by a constricting
band tightened by some other force
Means: The cause of death or mechanism responsible for causing the death
NC Child Fatality Prevention Team Annual Report, 2005. 38
Manner ( of death): How the death occurred
Manual strangulation: Pressure of a human hand/ limb on neck – compressing neck
structures
Mechanical asphyxia: Pressure on the outside of the body that prevents respiration
Natural ( manner): Death can be attributed to internal processes such as illness or disease
Non- Resident: Child's residence is listed outside of North Carolina ( regardless of whether or
not the onset of illness or injury occurred in NC)
Occupant ( motor vehicle): the decedent was riding in a vehicle
Overlying: When a person lies on a child leading to in lack of oxygen or respiration
Positional asphyxiation: When the decedent becomes trapped in a position and respiration is
compromised
Sleep Environment: The location, surface and additional items located where the child was
sleeping
Smothering: Mechanical obstruction or occlusion of the external airways
Suicide ( manner): Fatal injury was intentionally inflicted by the decedent
Toxin: A prescription drug, illicit drug, chemical, gas that is capable of causing fatal injury
Undetermined ( manner): Available information did not lead to a conclusion of manner
Undetermined ( means): Available information did not identify a cause of death
Vehicle: A mode of transportation, usually motorized

Fatalities of Children in
North Carolina
2005
Annual Report
North Carolina Child Fatality Prevention Team
North Carolina Office of the Chief Medical Examiner
2007
NC Child Fatality Prevention Team Annual Report, 2005.
STATE OF NORTH CAROLINA
Michael F. Easley, Governor
DEPARTMENT OF HEALTH & HUMAN SERVICES
Dempsey Benton, Secretary
DIVISION OF PUBLIC HEALTH
Leah Devlin, State Health Director
www. ncdhhs. gov www. ncpublichealth. com
The Department of Health and Human Services does not discriminate on the basis of race, color, national origin, sex, religion, age or
disability in employment or the provision of services.
Copies of this document can be found at: www. ocme. unc. edu
NC Child Fatality Prevention Team Annual Report, 2005.
OFFICE OF THE CHIEF MEDICAL EXAMINER
John D. Butts, MD
Chief Medical Examiner
Deborah L. Radisch, MD, MPH
Associate Chief Medical Examiner & Child Fatality Prevention Team Director
CHILD FATALITY PREVENTION TEAM &
OFFICE OF THE CHIEF MEDICAL EXAMINER
STAFF
Krista Ragan, MA
Child Death Investigation & Research
Lisa Mayhew, MS
Child Death Investigation & Training
North Carolina Department of Health and Human Services
Division of Public Health
Office of the Chief Medical Examiner
Brinkhous- Bullitt Building UNC- CH
Campus Box 7580
Chapel Hill, North Carolina 27599- 7580
Courier 17- 61- 02
Tel ( 919) 445.4414
Fax ( 919) 962- 6263
Report Prepared By:
Krista Ragan, MA, Child Fatality Research Director
Deborah Radisch, MD, MPH Director of the NC Child Fatality Prevention Team
North Carolina Child Fatality Prevention Team, Office of the Chief Medical Examiner
NC Child Fatality Prevention Team Annual Report, 2005.
North Carolina Child Fatality Prevention State Team Membership
2006- 2007
Chair
John Butts, MD
Chief Medical Examiner
NC Department of Health and Human Services
Deborah Radisch, MD, MPH ( designee)
Associate Chief Medical Examiner
Child Fatality Prevention Team Director
NC Department of Health and Human Services
Members
Selena Berrier
NC Child Fatality Task Force
Keith Davis
Division of Social Services
NC Department of Health and Human Services
Al Deitch
Youth Advocacy & Involvement Office
NC Department of Administration
Mike East
North Carolina State Bureau of Investigation
Brenda Edwards
Division of Public Health
NC Department of Health and Human Services
Anita Evans
Division of Social Services
NC Department of Health and Human Services
Cynthia Floyd
NC Department of Public Instruction
Phyllis Fulton
Division of Social Services
NC Department of Health and Human Services
NC Child Fatality Prevention Team Annual Report, 2005.
Kim Howes
Prevent Child Abuse NC
Gerri Mattson, MD
Children & Youth Branch
NC Department of Health and Human Services
Susan E. Robinson
Office of Prevention & Early Intervention
Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
NC Department of Health & Human Services
Shikha Sinha
Public Representative
Angenette Stephenson
Office of the Attorney General
State of North Carolina
Jane Volland
Guardian Ad Litem Program
NC Administrative Office of the Courts
John Weil
Division of Social Services
NC Department of Health and Human Services
NC Child Fatality Prevention Team Annual Report, 2005.
Table of Contents
Introduction .................................................................................................. 1
The North Carolina Child Fatality Prevention System..................... 1
Methods............................................................................................. 1
Notes about the data.......................................................................... 1
Executive Summary...................................................................................... 3
Key Data Points............................................................................................ 6
Accidental Deaths......................................................................................... 7
Asphyxiation..................................................................................... 7
Drowning........................................................................................... 9
Fire................................................................................................... 11
Gun .................................................................................................. 11
Vehicle............................................................................................. 12
Toxins.............................................................................................. 20
Other................................................................................................ 23
Homicides.................................................................................................... 24
Child Abuse Homicide.................................................................... 24
Other Homicide............................................................................... 25
Natural Deaths............................................................................................. 26
Sudden Infant Death Syndrome...................................................... 27
Suicides....................................................................................................... 30
Undetermined Manner................................................................................ 32
Neglect........................................................................................................ 33
Non- North Carolina Resident Deaths......................................................... 34
Fetal Deaths................................................................................................. 36
Glossary....................................................................................................... 37
NC Child Fatality Prevention Team Annual Report, 2005. 1
Introduction
The North Carolina Child Fatality Prevention System was established by the legislature in
1991 with the creation of the Child Fatality Task Force. In 1992, the North Carolina Child
Fatality Prevention Team ( State Team) was created. Local ( county) Child Fatality Protection
Teams ( CFPTs) followed in 1995. The purpose of the system is to:
( 1) develop a community- wide approach to the problem of child abuse and neglect,
( 2) understand the causes of childhood deaths;
( 3) identify any gaps or deficiencies that may exist in the delivery of public agency
services that are designed to prevent future child abuse, neglect, or deaths;
( 4) make and implement recommendations for changes to laws, rules, and policies that
will support the safe and healthy development of our children and prevent future child
abuse, neglect, and deaths.
The State Team has the important duty of reviewing all deaths of children under the age of
18 years that occur within North Carolina and that are investigated and certified by the
Office of the Chief Medical Examiner ( OCME). The State Team then presents
recommendations to the Task Force for changes to any law, rule, or policy that would
promote the safety and well- being of children.
This report is also a resource for public education to encourage the citizens of North Carolina
to actively participate in improving the safety and well- being of the children of North
Carolina.
Methods
The State Team reviews all deaths of children that are investigated by the OCME. Deaths
reported to the OCME include: accidents, homicides, suicides, violent deaths, suspicious
deaths, and sudden, unexpected deaths ( including some natural deaths).
State Team staff examines each case and determines if additional data should be gathered for
a thorough review. Additional information that is often requested includes: law enforcement
reports, medical records, Child Protective Services records, and other information deemed
pertinent to the review.
Notes About the Data
Data Exclusions
Not all deaths of children that are investigated by the OCME are included in the main
summary throughout this report. These deaths, and reasons for exclusion, are:
Fetal Deaths
A small number of fetal deaths are reported to the OCME each year due to a number of
factors. A fetal death is a death of fetus that never lived outside of the uterus. A certificate of
NC Child Fatality Prevention Team Annual Report, 2005. 2
fetal death indicates that there was no birth; therefore, these deaths are not included in child
fatality numbers. However, they are reported separately in this report.
Non- Residents
When a person dies in North Carolina, a North Carolina death certificate will be issued. This
includes individuals who may be here on vacation, visiting or just passing through. In many
instances, decedents were injured in neighboring states and were brought to a hospital in
North Carolina for treatment and subsequently expired. Since the State Team is charged with
the protection of the child residents in North Carolina, non- residents are not included in the
overall tally. However, to ensure that these deaths do not get lost in the system, and
recognizing that some of these deaths may be due to risks found in North Carolina, the deaths
are recorded separately at the end of the report.
Differences Among Data Sets
State Center for Health Statistics Data
Data released from the State Center for Health Statistics ( SCHS) are based solely on death
certificate coding. The SCHS data set includes all deaths of children in North Carolina. As
not all deaths are reported to the OCME, the SCHS numbers are higher mainly due to the
natural deaths that are reported to the State Center. The data sets for the SCHS also close,
meaning that the counts for a particular period of time will not change if the death certificate
is revised. The OCME data never close. A cause and manner of death can change if new
evidence is found that would deem the change necessary. Also, the CFPT collects additional
information on each death and performs an in- depth review of each case. This information
allows the CFPT to analyze and classify data differently than the State Center.
Differences among CFPT Data Sets
Annual data sets may differ from time to time in CFPT data reports. There are several
reasons for the differences. The first is that a death may not be discovered in the same year as
it occurred. For instance, if a death occurred in 2005 but was not reported to the OCME until
2007, it would be an additional 2005 death. The State Team also database underwent a
transformation in 2006, collecting more detailed data so that deaths can be analyzed in
greater detail. These data may not have been available or collected in previous years and may
be reflected somewhat differently in newer reports.
Rates
The SCHS releases deaths based on population rates. Rates will not appear in this report
because the numbers are generally too small to have significant meaning. As not all child
deaths are investigated by the OCME, rates are better reported by the SCHS which handles
all birth and death certificates as well as population data. Data for 2005 from the State Center
can be found at www. schs. state. nc. us/ SCHS/ deaths/ child/ cd2005. html
NC Child Fatality Prevention Team Annual Report, 2005. 3
Executive Summary: Child Fatalities in North Carolina in 2005
The NC State Center for Health Statistics ( SCHS) reported that there were 1614 deaths of
residents of North Carolina under the age of 18 years in 2005. While 625 total child fatalities
were investigated by the Office of the Chief Medical Examiner, 24 deaths were of out- of-state
residents and 18 were fetal deaths. Therefore, of the deaths in 2005 that were reviewed
by the CFPT, 583 were child residents of North Carolina ( 36% of resident child deaths).
Age Group SCHS CFPT Percentage
Infant 1077 222 21%
1- 4 years 141 80 57%
5- 9 years 86 51 59%
10- 14 years 111 63 57%
15- 17 years 199 167 84%
Total 1614 583 36%
Table 1. Child Fatalities in North Carolina, 2005.
This report reflects only data obtained through review by the State Child Fatality Prevention
Team ( CFPT).
Deaths by Manner and Age
Infants
The leading manner of death for infants was natural, 67% ( 148) of infant deaths. Of those
deaths, 73% ( 108) were classified as Sudden Infant Death Syndrome ( SIDS). The second
leading manner of death was accident making up 21% ( 47) of the deaths, followed by
homicide at 9% ( 19).
Other Age Groups
Accidents were the leading manner of death for all age groups from 1 year through 17 years,
making up 37% of the deaths. The other manners of death varied with age groups.
• For both the 1 to 4 years and 5 to 9 years age groups, the second leading manner of
death was natural, accounting for 26% and 22% respectively. The third leading
manner of death for these two age groups was homicide, accounting for 18% of
deaths in the 1 to 4 years group and 8% of the deaths of the 5 to 9 years group.
• For the 10 to 14 years age group, natural causes and homicide were the second
leading manners of death, each accounting for 13% of the deaths. The third leading
manner of death for this age group was suicide, at 11%.
• Homicide was the second leading manner of death for the 15 to 17 years age group,
with 20% of the deaths, followed by suicides with 13%.
NC Child Fatality Prevention Team Annual Report, 2005. 4
Accidental Deaths
There were 262 accidental deaths in 2005:
• Vehicle 61 %
• Asphyxiation 17 %
• Drowning 6 %
• Toxin 6 %
• Firearm 1.5%
• All other means accounted for 1% or less ( each) of the total number of accidental
deaths
Vehicle- related deaths accounted for the greatest number of accidental deaths. Accidental
asphyxiation made up a rather large proportion of accidental deaths considering all means
categories; this category has increased by 35 percent in the past six years.
Homicides
There were 79 homicides in 2005:
• Child Abuse Homicides 44%
• Other homicides 56%
Child Abuse Homicide victims were more often under the age of 4 years while other child
homicide victims were more likely to be between the ages of 15 and 17 years.
Natural Deaths
There were 197 natural deaths in 2005:
• SIDS 55%
• Other 45%
The majority of SIDS deaths occurred at the age of 6 months and younger and peaked
between the ages of 1 and 2 months. Other natural deaths were mainly due to respiratory tract
infections, myocarditis, asthma and neurologic conditions.
Suicides
There were 28 suicides in 2005:
• Firearm 61%
• Asphyxia 39%
The majority of decedents were white males. The cause of death in the majority of deaths
was a gunshot wound while the remaining deaths were due to asphyxiation. Approximately
1/ 3 of the decedents had been diagnosed with a mental health disorder.
NC Child Fatality Prevention Team Annual Report, 2005. 5
3.99 4.15
49.25
9.31
45 33.27
13.55
33.61
4.8 3.08
0
20
40
60
80
100
Accident Homicide Natural Suicide Undet
2004
2005
Figure 1. Percent Total Change from 2004 to 2005, NC Child Fatalities.
According to CFPT data, total accidental child fatalities decreased by 4.25% from 2004 to
2005. Homicides, however, increased by the same amount ( 4.25%) from 2004. Natural
deaths reviewed by the CFPT remained steady at approximately 33% of the total child
fatalities for both 2004 and 2005. Suicides increased by 1% and undetermined manner deaths
decreased by 1 percent.
NC Child Fatality Prevention Team Annual Report, 2005. 6
KEY DATA POINTS
Accidental Asphyxiation:
• The number of child deaths from accidental asphyxia has increased 35% over
the past 6 years.
• The majority ( 82%) of children dying by accidental asphyxia were under the age
of 1 year.
• The total number of deaths from accidental overlying in 2005 ( 23) was 2 ½ times
the number seen in 2003.
• Sleep environment was a direct cause of or contributed to the death in 37 of the
45 accidental asphyxiation deaths.
o Approximately half ( 55%) of the decedents who died from asphyxia while
co- sleeping were sleeping with only 1 adult.
• Other environmental factors such as soft sleep surface or access to dangerous
items caused the deaths of several infants.
* for a full report on accidental asphyxiation deaths of infants, please contact the CFPT.
Accidental Drowning:
• The majority ( 71%) of drowning deaths occurred when children were
unsupervised.
• Younger children were more likely to drown when falling into the water rather
than participating in a water activity while older children were more likely to
drown in natural bodies of water while swimming.
Accidental Vehicle Deaths:
• The majority of motor vehicle occupant deaths were child passengers ( 66%).
• In child passenger deaths, the driver of the vehicle in which the decedent was an
occupant was found to be at fault in 78% of the crashes.
• For teen drivers, the main factors in crashes were error ( 30%) or speed and
error ( 22%).
• Teen passengers were least likely to wear seatbelts ( 39%), and only half ( 53%) of
teen drivers were wearing seat belts.
• Only 1 of the 7 ATV riders was wearing a helmet. Notably, a state law that
requires all ATV riders to wear helmets went into effect December 2005.
Homicides:
• The number of homicides in 2005 ( 79) was the greatest number recorded since
2000. Both Child Abuse Homicides and “ Other” homicides are increasing.
Suicides:
• The majority of firearm suicides involved handguns.
• Approximately 1/ 3 ( 36%) of the decedents had a diagnosed mental health
disorder.
NC Child Fatality Prevention Team Annual Report, 2005. 7
ACCIDENTAL DEATHS
Accidental death was the leading manner of death for children ages 1 year to 17 years in
North Carolina in 2005 with 262 deaths. Accidental deaths are those deaths that occur in
which there was 1) no intent to harm self or another, or 2) there was no knowledge that a
person would be seriously injured by their own or another’s action. Accidental deaths may
also be termed “ unintentional.” Accident is used in this report because that is the manner of
death used on the death certificate.
Figure 2. Accidental Deaths by Means, NC Children, 2005.
Examination of accidental deaths by means showed:
• The majority ( 61%) of accidental fatalities occurred in vehicle collisions.
• Asphyxiation accounted for 17% of accidental deaths.
• Drowning deaths accounted for slightly more than 6% of accidental deaths.
• Accidental toxicity ( drugs, poisons, etc.) accounted for another 6% of deaths.
• Fire- related injuries comprised 4% of accidental deaths.
• Firearm injuries accounted for 1.5% of accidental deaths.
• All other accidental means accounted for 1% or less ( each).
Accidental Asphyxiation Deaths
Data indicate child deaths from accidental asphyxiation in North Carolina are on the rise. The
peak number of 45 occurred in 2005, which was a 181% increase from 2000, when the
number was just 16 deaths. Infants are most at risk for asphyxiation, with sleep practices
being important factors in this type of death.
The majority of children were white at 49% ( 22), followed by black at 42% ( 19), and Asian
at 2% ( 1). Three ( 7%) of the children were of Hispanic ethnicity ( race was not identified).
45
17 11 4 16 8
161
0
20
40
60
80
100
120
140
160
180
Asphyxia
Drowning
Fire
Gun
Vehicle
Toxin
Other
NC Child Fatality Prevention Team Annual Report, 2005. 8
37
4
1 2 1
0 5
10
15
20
25
30
35
40
Infant
1- 4 years
5- 9 years
10- 14 years
15- 17 years
Figure 3. Accidental Asphyxiation Deaths by Age, NC Children, 2005.
Asphyxiation deaths can be broken into categories by examining the circumstances of the
death. In 2005, the circumstances were as follows:
5
23
8
4 5
0
5
10
15
20
25
Asp/ Choke
Overlying
Positional
Smothering
Other
Figure 4. Accidental Asphyxia Deaths by Category, NC
Children, 2005.
Asphyxia and Sleep Practices & Environment
Of the 45 deaths, risky sleep practices or environment were found to be contributory, if not
responsible for the death in 37 cases:
• Co- sleeping occurred in 89% ( 33) of the deaths.
o In 70% of the deaths, co- sleeping was the direct cause of death ( overlying).
o The remaining deaths were positional ( 15%), smothering ( 12%) and 1
mechanical asphyxiation death.
o The majority of decedents ( 55%) were co- sleeping in beds, followed by 39%
sleeping on couches.
o In 55% ( 18) of the deaths, the child was sleeping with only one adult,
followed by both parents/ adults and a sibling( s) at 24% ( 8).
The majority of
children who died
from accidental
asphyxia in 2005
were under the age
of 1 year ( 82%).
Male children
made up 60% ( 27)
of the deaths, and
females made up
40% ( 18) of the
deaths.
Approximately half ( 51%) of
the accidental asphyxiation
deaths in 2005 were due to
overlying. Positional asphyxia,
which occurs when someone's
position prevents them from
breathing adequately, accounted
for 18% of the deaths,
aspiration or choking for 11%
of the deaths and smothering for
9% of the deaths. There was one
death from hanging, one death
from ligature strangulation, 2
deaths from mechanical
asphyxiation, and 1 death from
entrapment.
NC Child Fatality Prevention Team Annual Report, 2005. 9
o In 15% ( 5) of the deaths, the co- sleeper was known to be under the influence
of drugs and/ or alcohol at the time of the death.
􀂃 In 67% of the deaths, no information was available about the co-sleeper’s
drug or alcohol use.
• Sleep surface/ environment ( i. e. soft surface, access to strings, etc) was a factor in 4
deaths.
Other Asphyxiation Deaths
There were 8 deaths in which sleep environment was not a factor in the death. These deaths
included:
• Two deaths of children ages 2 years and 15 years who choked on food while eating.
• One death of a 14- year- old who died when a sand pile collapsed on him ( entrapment).
• One death of a 5- year- old who died after being found underneath a forklift
( mechanical).
• One death of a 13- year- old as a result of accidental hanging.
• Two deaths of 1- year- olds from aspiration ( one of which aspirated cleaning solution
when falling into a bucket, the other aspirated food).
• One death of an infant less than a month old who aspirated on formula when the
infant was left alone to feed with a bottle propped up on a pillow.
Accidental Drowning Deaths
In 2005, there were 17 child deaths due to drowning. The majority of deaths occurred in
natural bodies of water. In North Carolina, the largest factor in childhood drowning deaths is
lack of supervision.
Figure 5. Accidental Drowning Deaths by Race, NC Children, 2005.
Five children were 4 years old or younger, five children were between the ages of 5 years and
9 years. Three children were between the ages of 10 years and 14 years. Four children were
between the ages of 15 years and 17 years.
Half ( 9) of the children
who drowned were white.
Four ( 24%) were black
and 1 was identified as
biracial. Four ( 22%) of the
children were Hispanic,
and 3 of those did not
have an identified race.
Sixteen decedents were
male and 1 was female.
52%
24%
6%
18%
White
Black
Biracial
Unknown
NC Child Fatality Prevention Team Annual Report, 2005. 10
Three main activities resulted in drowning deaths:
• Falls
o All of the children 6 years old and younger died after falling into water while
walking, playing or during an unknown activity.
• Swimming
o All of the teenagers aged 15 to 17 years died while swimming. A 12- year- old,
a 7- year- old and an 8- year- old also died while swimming.
• Boating
o Two 14- year- olds died while boating ( separate incidents).
There were several locations in which drowning occurred:
• The majority ( 59%) of deaths occurred in natural bodies of water:
o 3 children died in ponds
o 3 children died in the ocean
o 2 children died in rivers
o 2 died in lakes
• Six ( 35%) children drowned in pools and one child ( 6%) died in a hot tub:
o 5 of the pools had fencing, 1 fence was noted to be in disrepair
o 3 of the pools were in- ground, 2 were above- ground and one pool type was
not identified.
2 2 1
2 3
2 1
4
0
2
4
6
8
10
12
Natural Pool Hot Tub
15- 17 years
10- 14 years
5- 9 years
1- 4 years
Figure 6. Accidental Drowning Deaths by Age and Location, NC Children, 2005.
Younger children ( 9 years and under) drowned in pools/ hot tub at only a slightly higher
number than in natural bodies of water. Older children ( 10 years and older) almost
exclusively drowned in natural bodies of water.
Supervision status and lack of safety precautions were the main factors in drowning deaths:
• The majority of decedents ( 71%) were not being supervised at the time of the
drowning.
• Only 3 children, all teenagers, were known to be able to swim.
• No child was wearing a personal flotation device ( PFD) at the time the drowning
occurred.
NC Child Fatality Prevention Team Annual Report, 2005. 11
Accidental Fire & Burn Deaths
There were 10 child fatalities due to 8 residence fires and 1 death due to burns from an
accidental gasoline fire.
5
4
1 1
0
1
2
3
4
5
6
1- 4 yrs 5- 9 yrs 10- 14 yrs 15- 17 yrs
Figure 7. Fire Deaths by Age, NC Children, 2005.
In residence fires, the structures were:
• Houses in 2 deaths.
• A mobile home in 1 death.
• Apartments in 3 deaths.
• In 2 deaths the structure information was unavailable.
The causes of fatal fires in 2005 were:
• Cooking in 3 deaths.
• Children playing with lighters in 2 deaths.
• A kerosene heater in 1 death.
• Faulty wiring in 1 death.
• A smoldering cigarette in 1 death.
• In 2 deaths the cause of the fire could not be determined.
Supervision and safety precautions:
• In 7 deaths there was no supervision or a lack of proper supervision at the time of the
fire.
• In 3 of the 8 residential fires, the residence was known to have an operational smoke
detector. In the remaining 5 fires records did not indicate if there was an operational
smoke detector in the home.
Accidental Firearm Deaths
Of the 61 gun deaths of children in North Carolina in 2005, 4 deaths were determined to be
accidental in nature. Accidental firearm deaths generally are assigned this manner when the
Five children were
between the ages of 1 and
4 years, 4 children were
between the ages of 5 and
9 years. One child was 13
years of age and 1 child
was 17 years of age.
Five children were black,
6 were white. Six children
were male and 5 children
were female.
NC Child Fatality Prevention Team Annual Report, 2005. 12
child shot himself or herself unintentionally or the shooter was another child who most likely
did not know the consequences of his or her actions.
All decedents were male. Three ( 3) children were white and 1 was black. The decedent ages
were:
• 4 years
• 6 years
• 12 years
• 13 years
The circumstances of these deaths include:
• In 2 deaths the decedent was shot by another child while playing.
• In 2 deaths the wounds were accidentally self- inflicted.
o One death was a hunting accident.
o In one death the decedent found a weapon and accidentally shot himself.
• In 3 deaths an adult was present at the time of the fatal injury, but in no deaths were
the children under immediate supervision; in 1 death no adult or supervisor was
present.
• Three of the children were killed in their own homes; one child was outdoors.
The weapons were a handgun, a shotgun and 2 rifles. Gun storage safety laws were
created to prevent these types of deaths. In 1 death the firearm was being used in a hunting
scenario and gun storage laws did not apply. Gun storage information on the remaining
cases include:
• In all 3 deaths the weapons were not properly stored and were easily accessible to
children.
o In 2 deaths the owner or responsible party for the weapon was charged with
failure to secure a firearm.
o In 1 death the child’s caretakers were each charged with failure to secure a
firearm and involuntary manslaughter.
Vehicle- Related Accidental Deaths
Vehicle- related death is the leading means of death of children over the age of 1 year in
North Carolina. In 2005, 161 children died as the result of injuries sustained in vehicular
crashes.
To better understand how our children are dying, the circumstances of the motor vehicle
deaths were analyzed and broken down into categories:
• There were 112 deaths in which the decedent was the driver or a passenger in a
automobile at the time of the fatal injury ( occupant).
NC Child Fatality Prevention Team Annual Report, 2005. 13
• 24 children died as a result of being struck by a motor vehicle while walking or
standing near a street or in a driveway ( pedestrian).
• There were 7 deaths resulting from ATV crashes.
• There were 7 children who were struck while riding a bicycle.
• 3 children were struck while driving a motorcycle/ motorbike.
• 8 deaths were coded as other vehicle/ transportation deaths.
Motor Vehicle Occupant Deaths
Decedents were either a driver or passenger in a motor vehicle in 104 crashes resulting in 112
deaths:
• Decedents were drivers in
33% ( 37) of the crashes.
• Decedents were passengers in
65% ( 73) of the crashes.
• Two infants were born as a
result of maternal trauma in a
motor vehicle accident and
died shortly after the crash.
Figure 8. Vehicle deaths by Decedent Position, NC Children, 2005.
Decedent as Driver
There were 37 deaths in which the decedent was the driver of the vehicle:
• Half of the drivers ( 18) were 17 years old.
• 46% ( 17) were 16 years old.
• 1 driver was 15 years old.
• 1 driver was 8 years old ( unsupervised on private road).
Male drivers accounted for 70% of fatalities, females for 30% of deaths. The majority of
drivers were white 75% ( 27) and black drivers made up 22% ( 8). Two drivers were Hispanic.
Driver Seatbelt Use
In 51% ( 19) of the fatalities, the decedent ( driver) was known to be wearing a seatbelt and in
43% ( 16) the driver was not wearing a seatbelt. In 2 deaths information was not available or
seat belt use could not be determined.
32%
66%
2%
Driver
Passenger
Other
NC Child Fatality Prevention Team Annual Report, 2005. 14
34%
21% 15%
18%
12%
Error
Speed
Speed/ Error
Impairment
Other
Figure 9. Crash Cause when Decedent was at Fault, NC Children, 2005.
Driver Circumstance Information
Eighteen ( 49%) of the accidents were single- vehicle crashes and in 34 ( 92%) deaths the
decedent was responsible for the crash.
In deaths in which the decedent was responsible:
• Error was present in all of the crashes, but speed was also a factor in 15, weather in 3
deaths and other factors in 2 deaths.
• The main contributing factor in an additional 7 crashes was impairment due to
alcohol ( excessive speed was also present in 4 of these deaths).
Decedent as Passenger
There were 73 deaths of children who were passengers in motor vehicles when they sustained
fatal injuries and additional 2 children who died after being born due to the trauma of the
crash. Data here will address the 73 passengers.
Age Group Count
< 1 year 4
1- 4 years 9
5- 9 years 11
10- 14 years 16
15- 17 years 33
Total 73
Table 2. Passenger Deaths by Age Group,
NC Children, 2005.
Teenagers between the ages of 15 and 17 years accounted for the majority ( 45%) of
passenger deaths. The 10- 14 years age group accounted for 22% of the deaths, the 5- 9 years
group for 15% of the deaths and 1- 4 years for 12% of passenger deaths. Infants accounted for
the least ( 5%) amount of deaths.
NC Child Fatality Prevention Team Annual Report, 2005. 15
The majority of decedents were male ( 55%, 40) and 45% were female ( 33). White children
accounted for 60% ( 44) of the passenger deaths, black children for 25% ( 18), 2 children were
Native American, and 1 child was Asian. Eight children were of Hispanic ethnicity.
Passenger Seatbelt Use
Decedents were wearing a seat restraint or a child restraint in 47% ( 34) of the crashes.
Children between the ages of 1 and 4 years were most likely to be restrained ( 78%) while
the 15- 17 year age group passengers were least ( 39%) likely to be restrained. In 6 deaths the
information was not available or it could not be determined whether or not the decedent was
wearing a restraint.
36%
11%
30%
18%
5%
Error
Speed
Error & Speed
Impairment
Other
Figure 10. Passenger Deaths by Crash Cause, NC Children, 2005.
Passenger Circumstance Information
In 39 ( 53%) deaths, the crash was a single vehicle accident. The driver of the vehicle in
which the decedent was a passenger was found to be at fault in 56 ( 78%) of the deaths. In
these deaths, a teenager ( 15 through 17 years) was at fault in 18 deaths.
Crash causes in these deaths included:
• Driver error ( 22)
• Speed ( 7)
• Error and speed ( 18)
• Impairment by drugs and/ or alcohol or impairment ( with additional factors) was
present in 14 deaths.
o In 7 deaths, the supervisor of the decedent was the impaired driver.
􀂃 In 4 of those deaths, the driver was a parent of the decedent.
􀂃 In 2 deaths the driver was under the age of 21 years.
o Other ( 6)
o Unknown ( 9)
NC Child Fatality Prevention Team Annual Report, 2005. 16
Driver vs. Passenger Information
When examining occupant status of fatalities in motor vehicle crashes, 66% of the occupants
were passengers, 33% were drivers.
Age Group Driver % Passenger %
< 1 year 0 0 4 5%
1- 4 years 0 0 9 12%
5- 9 years 1 3% 11 15%
10- 14 years 0 0 16 22%
15- 17 years 36 97% 33 45%
Total 37 100% 73 100%
Table 3. Occupant Deaths by Position and by Age Group, NC Children, 2005.
The 15 to 17 year age group had the most passenger fatalities with 45%, followed by the 10-
14 year group ( 22%) and the 5 to 9 year group ( 15%).
Race Driver % Passenger %
Asian 0 0 1 1%
Black 8 22% 18 25%
Native Am. 0 0 2 3%
White 27 73% 44 60%
Hispanic 2 5% 8 11%
Total 37 100% 73 100%
Table 4. Occupant Deaths by Position and by Race/ Ethnicity, NC Children, 2005.
The majority of drivers were white ( 73%) as were the passengers ( 60%).
Table 5. Occupant Deaths by Position and Sex, NC Children, 2005.
Male drivers fatalities were more than double ( 70%) that of female driver fatalities.
Seat belt Use Driver % Passenger %
Yes 19 51% 34 47%
No 16 43% 33 45%
Unknown 2 5% 6 8%
Total 37 100% 73 100%
Table 6. Occupant Deaths by Position and Seatbelt Use, NC Children, 2005.
Of the 110 children who died in motor vehicle crashes, 48% were wearing seatbelts.
Approximately 51% of drivers were wearing seatbelts and 47% of passengers were wearing
seatbelts.
Sex Driver % Passenger %
Male 26 70% 40 55%
Female 11 30% 33 45%
Total 37 100% 73 100%
NC Child Fatality Prevention Team Annual Report, 2005. 17
Non- Occupant Deaths
There were 49 deaths of children who were not occupants of a vehicle.
24
7 7
3
8
0
5
10
15
20
25
30
Pedestrian
Bicycle
ATV
Motorcycle
Other
Figure 11. Non- Occupant Vehicle- Related Deaths, NC Children, 2005.
Pedestrian Deaths
There were 24 ( 47% of non- occupant deaths) children struck by a motor vehicle in 2005.
Age Group Count
1- 4 years 10
5- 9 years 3
10- 14 years 7
15- 17 years 4
Total 24
Table 7. Passenger Deaths by Age Group,
NC Children, 2005.
Children 4 years and under accounted for 42% of the pedestrian deaths. Ten children were
female and 14 were male. Ten children were black, 8 children were white, and 1 child was
Native American. Five children did not have an identified race but were noted to be of
Hispanic ethnicity.
NC Child Fatality Prevention Team Annual Report, 2005. 18
21%
79%
Driveway/ home Street
Figure 12. Pedestrian by Location of Injury, NC Children, 2005.
Pedestrian Circumstance Information
Nineteen ( 79%) decedents were struck in a roadway or street. All of the children struck in the
driveway or in front of their home were under the age of 5 years ( 5):
• Two children were struck by SUVs backing out of a driveway.
• Two children were struck by pickup trucks entering the driveway.
• One child was struck by a passenger car kicked out of gear by another child.
In 13 ( 54%) deaths, the driver of the vehicle was determined not to be at fault in the accident.
In most cases, the child ran into the road or was standing/ walking in or along the road when
they were unavoidably hit by a vehicle. Of the 7 deaths in which the driver of the vehicle was
determined to be at fault, 1 driver was impaired. In the remaining 4 deaths fault could not be
determined or was unknown.
Supervision information was difficult to obtain in motor vehicle- pedestrian collisions as the
information provided often comes from the DMV report and supervision status is not
captured on the form. Additional information may be obtained from Medical Examiner
reports or other sources. In the majority of deaths ( 58%) no information was available about
supervision. An adult supervisor was known to be present in 5 deaths under the age of 15
years and there was no supervision of 3 children between the ages of 10 and 14 years.
Bicycle Crash Deaths
There were 7 ( 17% of non- occupant deaths) children who died while riding bicycles that
were struck by motor vehicles:
Age Group Count
1- 4 years 0
5- 9 years 1
10- 14 years 3
15- 17 years 3
Total 7
Table 8. Pedal cyclist Deaths by Age Group,
NC Children, 2005.
NC Child Fatality Prevention Team Annual Report, 2005. 19
Six of the children were male, one was female. Three of the children were black and 2 of the
children were white. Two children were Hispanic.
Bicycle Circumstance Information
All of the decedents were struck while riding in the roadway or trying to cross a roadway.
In five deaths, the decedent was found to be at fault in the accident and in 2 deaths the driver
of the vehicle that struck the decedent was found to be at fault.
When examining safety issues:
• No child was wearing a helmet.
• In 4 deaths the child was not being supervised and in 3 deaths no information was
available about supervision.
ATV Deaths
There were 7 ( 17% of non- occupant deaths) children who died as a result of ATV crashes in
2005:
• 2 children were between the ages of 1 and 4 years
• 1 child was 5 years of age
• 2 children were between the ages of 10 and 14 years
• 2 children were 15 years of age
Two of the children were female and 5 of the children were male. Six children were white
and 1 child was black.
ATV Circumstance Information
Four of the deaths occurred at a residence or on private property, the remaining 3 occurred on
roads or highways. The four youngest children were passengers and the oldest 3 were drivers.
When examining safety issues:
• Only one child was known to be wearing a helmet ( no helmet information was
available in 1 death).
• In 3 deaths there was no supervision at the time of the crash
o In 1 death no information was available
o Adults were driving the ATV in 2 deaths
In addition to requiring helmet use the state’s ATV law, which went into effect in December
2005, also requires adult supervision for young ATV riders.
Motorcycle Deaths
There were 3 ( 7% of non- occupant deaths) deaths of children who were driving motorcycles.
All of the children were white males ages 8 years, 13 years and 15 years.
NC Child Fatality Prevention Team Annual Report, 2005. 20
Motorcycles in these cases included:
• 2 dirt bikes ( classified as motorcycles to be used off road)
• 1 small motorcycle
In 2 deaths the decedent drove into the path of an automobile on a road and in 1 death the
decedent struck another ATV.
When examining safety issues:
• Only one child was wearing a helmet.
• No information was available about supervision for any of these deaths.
Other
Other vehicular deaths don’t fit into the above categories for 1 of 2 reasons: 1) the vehicle is
not an automobile, or 2) the legal regulations that apply to motor vehicles would not apply in
these instances. There were 8 deaths that fell into this category.
• There were 3 deaths of teenage males ( 15 years, 16 years and 17 years) who were
walking on the train tracks when they were struck by a train.
• There were 2 children who were driving go- carts.
• There 12- year- old child who was riding a horse near a road ( while supervised) when
the horse darted into the road into the path of an oncoming vehicle.
• There was 1 death of a 6- year- old child who had sustained injuries years earlier when
he was struck by a riding lawn mower.
• There was one death of a 13- year- old male struck riding his skateboard.
Legal Ramifications
Charges were known to have been filed in 35 of all of the motor vehicle crash deaths and
charges were pending in another 7 cases. In 17 cases, more than one charge was filed.
Charges filed varied from regular traffic infractions to 2nd degree murder.
Accidental Toxin Deaths
Accidental deaths from toxins include accidental drug toxicity, unintentional ingestion of
chemicals, or exposure to lethal chemicals/ gases. There were 16 deaths due to toxins in 2005
( 2 deaths were related). The majority of these were of decedents who were misusing
prescription drugs for recreational purposes.
Most children ( 14) were between the ages of 15 and 17 years. One child was 14 years and
one child was 2 years old. Fifteen of the children were white and one child was black. Males
accounted for 13 deaths and females for 3 deaths.
NC Child Fatality Prevention Team Annual Report, 2005. 21
Decedents were most likely ( 56%) to be at home when they took a fatal dose of a toxin. In 4
deaths the decedent had taken drugs at a residence other than their own and in 3 deaths it was
not known or information was not available as to where the decedents were at the time they
took the toxin( s).
75%
6%
6%
13%
Recreational
Medical
N/ A
Undet
Figure 13. Decedent Drug Use Activity, NC Children, 2005.
The majority of decedents were using a toxin recreationally which resulted in their death:
• In 12 deaths the decedent was recreationally using a toxin ( or toxins) when they took
a lethal amount.
• In 1 death the decedent was taking the prescribed drug for medical reasons.
• In 1 death the child may have taken a drug not knowing that it was a drug.
• In 2 deaths the circumstances were unclear and it could not be determined why the
decedent was taking the drug( s) from the information available.
Ten of the decedents had a history of prior drug use and in 3 deaths there was a family
history of drug use.
Toxins
In 12 deaths the fatal toxin( s) was either a prescription drug or a mix of prescription and over
the counter ( OTC) drugs. In 3 deaths the toxins were combined prescription and illicit drugs.
In 1 death the decedent used a household chemical ( inhalant) to get high.
NC Child Fatality Prevention Team Annual Report, 2005. 22
3
12
3 1 4 2
13
1
3
2
1
1
1
1 0 2 4 6 8
10
12
14
16
18
Narcotics
Depressants
Stimulants
Anti- Depress
Other Rx
OTC
Other Illicit
Other
Lethal
Not- Leth
Figure 14. Positive Toxicology Findings in Accidental Toxin Deaths, NC Children, 2005.
As illustrated in Figure 14, very few decedents tested positive for only 1 toxin, with only 6
deaths ( 38%) resulting from a single toxin. In the 16 accidental toxin deaths, 48 toxins were
detected by toxicologic examination. These toxins included:
• Narcotics ( methadone, fentanyl, oxycodone, morphine, etc.)
• CNS depressants ( benzodiazepines, alprazolam, and barbiturates etc.)
• Stimulants ( i. e., prescription methamphetamine and illicit cocaine)
• Antidepressants ( i. e., sertraline)
• Inhalants
• Hallucinogens
• Other prescription drugs
• OTC drugs
In 5 deaths ( 31%) more than 1 drug was found to be present in a lethal amount and in another
5 deaths ( 31%) the decedent had 1 toxin present in a lethal amount but other drugs were
detected in non- lethal concentrations. Methadone was found in be lethal in 6 deaths, and the
sole lethal drug in 3 of those deaths.
Access to Toxins
Children and adolescents can gain access to legal and illegal drugs in a variety of ways from
a variety of locations:
• In 3 deaths the lethal toxin was in/ around the home, but not prescribed for the
decedent.
• In 1 death the decedent purchased the toxin at the store.
• In 1 death the drug was a prescription for the decedent for medical purposes.
• In 2 deaths the decedent had taken prescription drugs that were prescribed to him or
her as well as a prescription drug prescribed to someone else.
• In 1 death the decedent took a drug prescribed for someone else.
• In 4 deaths the decedent obtained the drug from a friend or acquaintance.
• In 4 deaths it was not determined how or where the child obtained the drug.
NC Child Fatality Prevention Team Annual Report, 2005. 23
Other Accidental Deaths
There were 8 deaths that occurred that can be classified as “ other accident” in 2005:
• Three deaths of infants occurred as a result of medical treatment ( surgical
complications) or drug reaction.
• An infant and a 7- year- old died from injuries sustained in falls ( separate incidents).
• A 2- year- old died when he pulled a heavy object over on himself.
• A 17- year- old male accidentally stabbed himself during an altercation.
• A 17- year- old male drowned in a ditch while trying to cross a flooded street after
heavy rain.
NC Child Fatality Prevention Team Annual Report, 2005. 24
HOMICIDE
There were 79 homicides in 2005. This is the greatest number of homicides recorded since
2000. Both Child Abuse Homicides ( CAH) and other homicides have been on the rise since
2002. Other homicides increased by 76% from 2004 to 2005.
Child Abuse Homicides
There were 35 homicides determined to be Child Abuse Homicides in 2005. The State Team
defines child abuse homicide as the death of a child that occurs from a physical injury and/ or
severe neglect that is perpetrated by the person in charge of the child's well- being at the time
of the fatal injury. Other homicides are those in which the decedent was killed by another
person, but not a person responsible for taking care of the child at the time of the death.
Victims of child abuse homicide were:
• Under the age of 4 years in 89% ( 31) of the deaths.
o Infants accounted for half ( 51%) of all child abuse homicides of NC residents
in 2005.
• Between the ages of 5 and 14 years of age in 2 deaths.
• Between the ages of 15 and 17 years of age in 2 deaths.
Figure 15. Fatal Injuries in North Carolina Child Abuse Homicides, 2005.
Causes of death vary, with 66% of victims dying from blunt trauma ( 6 of those from abusive
head trauma/ AHT). Asphyxiation was the cause of death in 4 fatalities. Scalding, lack of
newborn care and exposure resulted in 2 fatalities per cause of death. One child died from
stab wounds and 1 additional child died from drowning. In addition, half ( 18) of the children
showed evidence of abuse or a suspect admitted to abusing the child on more than 1
occasion.
Those suspected of inflicting the fatal injuries in child abuse homicides were either parents or
individuals responsible for the child’s well- being at the time of the injury:
Scalds
6%
Other
17%
AHT
17%
Asphyxia
11%
Blunt trauma
49%
NC Child Fatality Prevention Team Annual Report, 2005. 25
Suspected Perpetrators*
A biological parent was the suspected perpetrator in 43% ( 15) of the child abuse homicide
deaths:
• Mothers ( 7) and fathers ( 7) were equally suspected as perpetrators of fatal injuries,
with one case in which both a mother and father were charged.
• In 11% ( 4) of the deaths the stepfather alone was suspected.
• In 23% ( 8) of the deaths the mother’s boyfriend was charged with the murder, and in
2 of these deaths the mothers were also charged with lesser crimes related to the
death. In 1 death the mother and her boyfriend were both charged as primary
offenders.
• In 3 deaths the suspect was a male caretaker not related to the decedent, in 1 death the
babysitter was suspected, and in 1 death a family friend was suspected.
• No one was charged in 2 of the deaths, as primary suspects were not identified.
Other Homicides
There were 44 homicides of children that were not due to child abuse. Teenagers between the
ages of 15 and 17 years accounted for 73% ( 32) of the homicides.
Firearms were used in 89% ( 39) of the deaths, sharp instruments were used in 4 deaths and 1
homicide was due to drowning. Circumstance information varied greatly but included:
arguments, gang activity, perpetrating a crime, “ fooling around” with a weapon, domestic
violence, innocent bystander and in some deaths the circumstance information was not
available or not known.
Suspected Perpetrators*
The majority of suspects ( 51%) were between the ages of 15 and 21 years. The suspect-victim
relationships were:
• In at least 36% ( 16) of the deaths the decedent knew the suspect.
• Four decedents did not know the suspect before the death.
• In 4 deaths the suspect was not identified.
• In the remaining deaths ( 20, 45%) it was not known or information was not available
as to whether or not the decedent was acquainted with the suspect.
* NOTE: Suspected perpetrators are labeled as such as they have been charged with a crime but are presumed
innocent until found guilty in a court of law. The CFPT is tracking legal outcomes and the State Team will
report these findings at a later date.
NC Child Fatality Prevention Team Annual Report, 2005. 26
NATURAL DEATHS
The majority of natural child deaths in North Carolina are not reported to the Office of the
Chief Medical Examiner as they result from known illness or disease. However, sudden,
unexpected deaths of children in apparent good health must be reported to the medical
examiner. Most of these deaths will require an autopsy, with investigation, to determine the
cause and manner of death. In 2005, there were 208 deaths certified as natural manner. One
hundred and eight of these were finalized as Sudden Infant Death Syndrome and are
discussed later in this section. Another 12 deaths were fetal deaths and are discussed at the
end of this report.
Age Group Total
< 1 year 36
1- 4 years 18
5- 9 years 11
10- 14 years 7
15- 17 years 5
Total 77
Table 9. Sudden, Unexpected Deaths of Children
( excluding fetal deaths and SIDS) by Age Group, NC Children, 2005
The majority of children who died from sudden, unexpected death ( excluding SIDS and fetal
deaths were under the age of 1 year, accounting for 47% of these natural deaths. In fact, as
children got older, sudden unexpected death dramatically decreased.
Natural Causes of Death
Of the 77 remaining deaths, 69 ( 90%) were autopsied. In some deaths there may be overlap
such as when congenital abnormalities place a child at risk for pulmonary infections or may
involve serious heart defects that cause death. Deaths were categorized here by the main
factor contributing to the child’s death. Eight deaths were found to have no external cause of
death and were certified as natural in manner with unknown means. The top 4 ( as 2 causes
had the same number) causes of death were:
• Upper/ lower respiratory tract infections 15
• Myocarditis 11
• Asthma 5
• Neurologic conditions 5
Other natural causes of death varied and included: aspiration, complications of prematurity,
malignancy, meningitis, congenital heart disease, other congenital conditions, seizures,
complications of cerebral palsy, sepsis/ systemic viral illness, gastrointestinal infection, and
cardiomyopathy.
NC Child Fatality Prevention Team Annual Report, 2005. 27
Sudden Infant Death Syndrome
Sudden Infant Death Syndrome ( SIDS) is the sudden and unexpected death of an infant ( a
child under the age of 1 year). This cause of death should only be assigned when a complete
autopsy, complete scene investigation and a complete review of clinical history cannot show
any other cause of death. In North Carolina, the manner is determined to be natural. There
were 108 deaths certified as SIDS in 2005.
In North Carolina, most SIDS victims were less than 6 months old:
• SIDS deaths peaked between 1 and 2 months of age with 60% of all SIDS deaths
occurring between birth and 3 months.
• 98% ( 104) of SIDS deaths occur at the age of six months or younger.
11
26
28
14
12
10
3
1 2 1
0
5
10
15
20
25
30
< 1
mo
1 mo 2 mo 3 mo 4 mo 5 mo 6 mo 7 mo 8 mo 9 mo 10
mo
11
mo
Figure 16. SIDS deaths by Age, North Carolina Residents, 2005.
Demographics
Females accounted for 41% ( 44) of the SIDS fatalities and males for 59% of deaths. White
children accounted for 56% ( 61) of the deaths and black children for 33% ( 36). White males
accounted for 32% ( 35) of the deaths overall for a single race and sex. Seven ( 6%) of the
children were of Hispanic ethnicity.
Location of Death
The majority ( 92%) of children died at home while 2 died at licensed day care centers and 7
deaths occurred at residences other than the decedent’s home residence.
SIDS & Risk Factors
While the cause of SIDS is not known, “ risk factors” ( increase the risk for SIDS) have been
identified. These include tummy/ side sleeping, soft sleep surface/ loose bedding, smoking, co-sleeping,
preterm and low birth weights. Risk factor information in SIDS deaths for North
Carolina was:
NC Child Fatality Prevention Team Annual Report, 2005. 28
Bedding:
• In 50% ( 54) of the deaths, bedding information was not available or not known.
• In 23% ( 25) of the deaths, blankets were present and in 16% ( 17) of the deaths a
comforter was present with the decedent at the time of the death.
• Pillows were present in another 23% ( 25) of the deaths.
• In a small number of deaths ( 6), stuffed animals were in the sleeping area with the
decedent.
Co- sleeping & Sleep Surface:
• In 52% ( 56) of the deaths, the decedent was co- sleeping with at least one other
individual at the time of the death.
o Of the known co- sleepers, 30% ( 17) were sleeping with both parents at the
time of the death.
o The same number of children ( 17) were sleeping with the mother only.
o Infants were sleeping with at least 1 parent and 1 sibling in 21% ( 12) of the
deaths.
• Infants were sleeping in cribs in 20% of the deaths.
• The majority of infants were sleeping on sleep surfaces not intended for infant sleep
o Almost half ( 48%) of infants were sleeping in adult beds.
o Twelve were sleeping on couches.
o Four were sleeping in car seats.
o In 8 deaths ( 7%) the sleep surface was described as “ other”.
o In 9 deaths ( 8%) information about the sleep surface was not available.
30%
19%
14%
4%
33%
Back
Front
Side
Sitting
Unavail
Figure 17. SIDS Deaths and Infant body placement,
NC Children, 2005.
Infant Position:
• Slightly less than 1/ 3 ( 30%) of infants were known to be placed on their backs to
sleep, the recommended position for infant sleep.
• In 1/ 3 ( 33%) of the deaths, no information was available about the sleep position of
the infant.
NC Child Fatality Prevention Team Annual Report, 2005. 29
Smoker in the home:
• In 68% ( 74) of the deaths, it was not known if there was a smoker present in the
home.
• In 18% ( 20) of the deaths a smoker was present in the home
• 12% ( 13) of the homes did not have a smoker living in the residence
Pregnancy and Birth Risks:
• Approximately 28% ( 30) of the infants who died from SIDS were born prematurely.
o 14 of which were low birth weight.
• In 6% ( 6) of the deaths, the decedent was one product of a multiple birth.
• Mothers were known to have smoked during pregnancy in 9% ( 10) of the deaths.
NC Child Fatality Prevention Team Annual Report, 2005. 30
SUICIDE
In 2005, 28 children committed suicide in North Carolina. Seven of the children were
between the ages of 10 and 14 years and 21 were between the ages of 15 years and 17 years.
Suicide Circumstances
Circumstances surrounding suicides include location of occurrence, decedent and family
history and weapon use and access:
• The majority ( 24) of suicides took place at the decedent’s residence.
• Ten ( 36%) of the decedents had been diagnosed with a mental illness at some time
prior to their suicide.
• As in prior years, the mechanisms adolescents used to commit suicide were firearms
and asphyxia.
Firearms
Firearms were used in 61% ( 17) of the suicides:
• Males accounted for 82% ( 14) of the suicides by firearms, and 3 decedents were
female. Children between the age of 15 years and 17 years accounted for 76% ( 13) of
the deaths and 4 deaths were children ages 10 to 14 years.
• White children made up 76% ( 13) of the deaths, 3 children were black, and 1 child
did not have an identified race but was identified as Hispanic ethnicity.
53%
35%
12%
Handgun
Shotgun
Rifle
Figure 18. Suicides by Weapon/ Mechanism, NC Children, 2005.
• Handguns were used in 53% ( 9) of the deaths.
• Shotguns were used in 6 deaths and rifles were used in 2 deaths.
• In 47% of the deaths ( 8) the weapon belonged to a parent of the decedent.
• In 2 deaths the decedent was the owner of the weapon.
• In 5 deaths no information was available on the ownership of the gun or no one was
aware how the decedent obtained the gun.
NC Child Fatality Prevention Team Annual Report, 2005. 31
Gun storage information was as follows:
• In 1/ 3 of the cases ( 6), the storage information was not available in records or not
known.
• In 4 deaths the decedent was the owner of the gun ( 2) or storage was not applicable
( 2).
• In 2 deaths the guns were known to have been properly stored.
• In 5 deaths the firearm was known to be improperly stored.
• In only 1 of these deaths were charges brought against the owner of a firearm for
improper storage.
Asphyxia
Eleven ( 11) of the suicides were a result of asphyxia by hanging.
• Nooses included items found around the home such as electrical cords or belts.
• Eight ( 73%) of the decedents were female and 3 were male
• Teens aged 15 to 17 years accounted for 8 deaths ( 73%) and teens aged 10- 14 years
accounted for 3 deaths.
• White children accounted for 6 ( 55%) asphyxiation suicides, black children for 4
deaths and 1 child was identified as Hispanic ethnicity.
NC Child Fatality Prevention Team Annual Report, 2005. 32
UNDETERMINED MANNER
There were 18 deaths of children in 2005 for which a manner of death could not be
determined.
The majority of deaths that fell into this category were between the ages of 1 and 4 years ( 7),
followed by infants ( 6), 5- to 9- year- olds ( 3) and 15- to 17- year- olds ( 2).
Deaths that were undetermined in manner included:
• Deaths with an identified cause of death but with a manner or intent that could not be
determined from available investigative information:
o 1 death from a toxin
o 2 fire- related deaths
o 1 gun death
o 1 death by drowning
o 1 death by other means
• Deaths in which the cause of death was also undetermined ( 12) after an autopsy and
investigation could not provide information that could positively identify a particular
physical means of death.
NC Child Fatality Prevention Team Annual Report, 2005. 33
NEGLECT
Negligence can be defined as a failure to act, failure to attend to, or lack of due care. When
discussing child neglect, the definition can be dependent on legal, societal or cultural
standards. A consensus definition of child neglect does not exist. However, it is important to
examine the contribution of neglect in child fatalities when trying to determine prevention
strategies. The CFPT has modified existing neglect classifications so that we may better
capture the role of neglect in child deaths. For a death to be classified as neglect, the
following criterion must be met:
1. The act/ failure to act must be ( at a minimum) contributory to the death:
2. The person who committed the act or who failed to act must have had care- giving
responsibility for the child at the time of the fatal injury
3. The death could have been prevented if the caregiver had taken proper precautions
and/ or followed legal regulations meant to protect themselves and others.
A death can be classified as neglect when improper care, improper discipline, improper
supervision, inappropriate or lack of medical care, inappropriate parental behavior and/ or an
unsafe physical environment contributed to the death. It is also important to note that neglect
is not limited to accidental deaths; it can be a factor in other deaths as well. Also, the
numbers are undercounted, since complete circumstance information is not always available
for review. Other neglect may exist that is not related to the death.
Upon careful examination of the child fatalities in 2005, the CFPT concluded that 101 ( 17%)
of the 583 deaths of the cases reviewed met at least 1 category for neglect classification.
These deaths included:
• Abandoned infants 7
• Drowning 7
• Firearm 13
• Asphyxia 17
• Motor vehicle 23
• Blunt trauma 11
• Exposure 2
• Fire 7
• Scald 2
• Other 6
NC Child Fatality Prevention Team Annual Report, 2005. 34
NON- RESIDENT DEATHS
There were 24 deaths in North Carolina in 2005 of children who were residents of other
states or countries.
Of these, 16 deaths were accidents, 5 deaths were natural and 3 deaths were homicides.
Ages ranged from infants ( 6), 1- 4 years ( 5), 5- 9 years ( 4), 10- 14 years ( 2), 15- 17 years ( 7).
11
2 1
5
1 4
0
5
10
15
20
Accident Homicide Natural
Onset OOS
Onset NC
Figure 19. Location of Onset, Child Deaths in NC of Non- residents, 2005.
Accident
There were 16 accidental deaths:
• Motor vehicle crashes accounted for 12 child deaths.
o In 7 deaths, the crash occurred in North Carolina. Five of the crashes occurred
in nearby states and the child was brought to NC for treatment and they
subsequently died.
• Asphyxiation was the cause in 1 death ( onset in NC).
• Drowning was the means in 1 death ( onset in NC).
• One child died as a result of a gunshot wound ( onset in NC).
• Injuries sustained in a fall accounted for 1 death ( onset in NC).
Natural
There were 5 natural deaths:
• SIDS was the cause of death for 3 infants.
o Two of these deaths occurred in bordering states and the decedent was
brought to a hospital in North Carolina where the child was pronounced dead.
• One child had a terminal illness and was visiting in North Carolina.
• One child had myocarditis with a fatal event while visiting in North Carolina.
NC Child Fatality Prevention Team Annual Report, 2005. 35
Homicide
Three non- resident children died as a result of homicide:
• In 2 deaths, the children appeared to be living in North Carolina, but had a different
state listed as their residence on the death certificate.
o One death was a result of child abuse.
o One death a result of domestic violence.
• One child died from starvation ( child abuse) which occurred over a period of time and
in several states.
NC Child Fatality Prevention Team Annual Report, 2005. 36
FETAL DEATHS
Fetal deaths are not systematically reported to or investigated by the medical examiner
system. Eighteen fetal deaths were investigated in 2005 and 2 of those were listed as either
non- resident or no known residence. Of the 16 residents, 11 were determined to have been
Intrauterine Fetal Demise. The remaining 5 deaths were due to:
• Motor vehicle accidents 2
• Other accidental means 1
• Natural 1
• Undetermined/ Unknown 1
NC Child Fatality Prevention Team Annual Report, 2005. 37
GLOSSARY
Accident ( manner): The death was unintentional ( there was no intent to cause injury to the
decedent or another or lack of understanding that harm would result from actions
Asphyxiation: Lack of oxygen to the body/ brain ( for our purposes this will only refer to
deaths from lack of oxygen)
Aspiration: Inhalation or food/ liquid or gastric contents
ATV: All- Terrain- Vehicle
Child: From birth through the age of 17 years.
Child resident: under the age of 18 years living in North Carolina ( as noted on the death
certificate)
Choking: Obstruction within the air passage ( internal)
Co- sleeping: The child was placed to sleep on the same surface as at least one other
individual who was also sleeping/ intended on sleeping
Drowning: Water/ liquid prevents the body from obtaining oxygen resulting in death ( a form
of asphyxiation)
Entrapment: Trapped in an air- tight enclosure
Environmental deaths: Deaths that result from Cataclysmic storms ( i. e. winds and flooding
from hurricanes), cave ins, lightning and other natural environmental events.
Exposure: Result of hypothermia or hyperthermia.
Fetus: unborn young of a human being
Firearm: handgun, long gun, or modified weapon used to dispense projectiles
Hanging: Compression/ constriction of the neck structures by a constricting band tightened
under the victims body weight ( noose)
Homicide ( manner): Intentionally inflicted injury that is fatal or death is a known
consequence of an action by another
Infant: From birth to the 1st birthday
Ligature strangulation: Compression/ constriction of the neck structures by a constricting
band tightened by some other force
Means: The cause of death or mechanism responsible for causing the death
NC Child Fatality Prevention Team Annual Report, 2005. 38
Manner ( of death): How the death occurred
Manual strangulation: Pressure of a human hand/ limb on neck – compressing neck
structures
Mechanical asphyxia: Pressure on the outside of the body that prevents respiration
Natural ( manner): Death can be attributed to internal processes such as illness or disease
Non- Resident: Child's residence is listed outside of North Carolina ( regardless of whether or
not the onset of illness or injury occurred in NC)
Occupant ( motor vehicle): the decedent was riding in a vehicle
Overlying: When a person lies on a child leading to in lack of oxygen or respiration
Positional asphyxiation: When the decedent becomes trapped in a position and respiration is
compromised
Sleep Environment: The location, surface and additional items located where the child was
sleeping
Smothering: Mechanical obstruction or occlusion of the external airways
Suicide ( manner): Fatal injury was intentionally inflicted by the decedent
Toxin: A prescription drug, illicit drug, chemical, gas that is capable of causing fatal injury
Undetermined ( manner): Available information did not lead to a conclusion of manner
Undetermined ( means): Available information did not identify a cause of death
Vehicle: A mode of transportation, usually motorized